Understanding Alopecia Areata: Causes, Symptoms, and Treatments

Alopecia is a broad term for hair loss, and alopecia areata is a common type of non-scarring hair loss that can affect individuals of any age. Non-scarring means the hair roots are not permanently damaged, allowing for the possibility of regrowth. This condition typically results in small, round patches of baldness on the scalp, but it can also affect other body parts like the beard, eyebrows, and eyelashes. In some cases, larger areas or even the entire scalp (alopecia totalis) or body (alopecia universalis) can be involved. Nails may also show changes in some patients. Alopecia areata can affect all genders and both children and adults.

Unpredictable Hair Loss
The extent of hair loss in alopecia areata varies and is unpredictable. Hair may regrow on its own over months or years, but this is not guaranteed, and new patches can develop. The likelihood of regrowth is higher if less hair is lost initially. If more than half of the hair is lost, the chances of full recovery are lower. Hair often regrows white initially. Most people experience multiple episodes of alopecia areata, and those with alopecia totalis or universalis have a lower likelihood of complete regrowth without treatment.

Emotional Impact
A UK study found that individuals with alopecia areata have higher rates of depression and anxiety, affecting their daily lives. It’s important to discuss any social or emotional impacts with a healthcare professional who can provide support, whether through therapy, medication, or connecting with others who have similar experiences.

Causes of Alopecia Areata
Hair loss in alopecia areata is due to inflammation of the hair follicle. The immune system mistakenly attacks the hair follicles, halting hair growth. The exact cause is not fully understood. Alopecia areata is not contagious and is not linked to diet. Potential triggers include infections and stress, though these links are not definitive.

Alopecia areata is an autoimmune condition and is associated with other autoimmune diseases like thyroid disease, vitiligo, and type 1 diabetes, as well as atopic conditions such as eczema, hay fever, and asthma. If you have symptoms beyond hair loss, consult a healthcare professional for further evaluation.

Is Alopecia Areata Hereditary?
There is a genetic component to alopecia areata, with about 20% of affected individuals having a family history of
the condition. Multiple genetic factors are believed to play a role, but the exact triggers remain unclear.

Symptoms and Diagnosis
Alopecia areata causes sudden hair loss, which can affect any part of the body. Symptoms may include itching, burning, or tingling in the affected area. If eyelashes are affected, it can lead to dry eyes. Some people develop small pits on their nails or brittle nails.

The condition typically starts with one or more smooth, bald patches on the scalp. These patches are not inflamed or scaly and often affect pigmented hair, leaving some white hair within the bald area. Short, tapered hairs, known as exclamation mark hairs, may be seen at the edge of the bald patch. Regrowth usually begins with fine white hairs that thicken and regain their natural color over time.

Diagnosis is usually made by a doctor based on clinical assessment. Most patients do not need tests, but a scalp biopsy may be considered if the diagnosis is uncertain.

Prognosis and Treatment
There is currently no cure for alopecia areata. For many, hair regrowth occurs within a year without treatment, but further episodes of hair loss are common. The chances of regrowth are lower for those with extensive hair loss, young children, individuals with a family history of autoimmune conditions, those with hair loss at the back of the scalp, or those with nail disease.

Wigs and Camouflage
Some individuals may choose to wear wigs while waiting for hair regrowth. Wigs can be purchased privately or obtained through the NHS with a consultants prescription. Local hospital orthotic departments can provide advice on available hairpieces, and Alopecia UK offers guidance on choosing and caring for wigs.

Treatment Options

Treatment aims to manage symptoms and promote hair growth, though it cannot change the diseases course.
Options vary based on the severity of hair loss and should be discussed with a healthcare professional.

• Wigs and Cosmetics: Wigs and hairpieces can help regain confidence. Hair fibers and cosmetics can camouflage hair loss areas. Microblading and temporary eyebrow transfers can help with eyebrow loss.

• Topical Treatments: Corticosteroid creams, topical JAK inhibitors, dithranol cream, contact sensitization treatment, prostaglandin analogs, and minoxidil lotion are applied to the skin to stimulate hair growth.

• Systemic Treatments: Local steroid injections, corticosteroid tablets, oral JAK inhibitors, immunosuppressant tablets, biological therapies, and ultraviolet light treatment (PUVA) are used for more severe cases.

Other Treatments

• Complementary and Alternative Medicine (CAMs): Limited evidence supports the effectiveness of alternative therapies like aromatherapy for reducing depression and anxiety, though not for hair regrowth.

• Psychological Treatments: Hypnosis and mindfulness meditation can improve psychological well-being but do not affect hair regrowth.

Self-Care Tips
• Shaving remaining hair can be a solution for some.
• Protect bald patches from sunlight with sunblock or a hat.
• Be cautious to avoid scraping the scalp.
• Consult a hairdresser about dyeing regrown hair.
• Use hair extensions carefully to avoid traction alopecia.
• Artificial eyelashes, eyebrow pencils, and microblading can help with hair loss around the eyes.

For more information, consult your healthcare professional or visit resources like Alopecia UK.

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Medical reviewer: Dr Ahmad Moussa MB BCh, MSc, MRCS(Eng), MD, FRCS(SN), NHS Neurosurgeon and Hair Transplant Surgeon.

Published: 20 November 2024. Last updated: 20 June 2026. Last reviewed: 20 May 2026. All prescription medications are dispensed by a GPhC registered UK partner pharmacy.