We may think of all hair loss as the same: hair falls out, leading to a bare patch or an area of thinning hair. However, there are many types of hair loss, one of which is called alopecia areata.
We may think of all hair loss as the same: hair falls out, leading to a bare patch or an area of thinning hair. However, there are many types of hair loss, one of which is called alopecia areata.
Alopecia areata is an autoimmune condition in which the immune system mistakenly attacks hair follicles, the small structures in the skin where hair grows from. This immune attack disrupts the hair growth cycle, leading to patchy hair loss on the scalp and, in some cases, other hair-bearing areas of the body.
Want to know more about alopecia areata? We’ll cover what alopecia areata is, its symptoms, causes, risk factors, treatment options, and more.
Alopecia areata is an autoimmune disorder that typically causes distinct round or oval patches of hair loss. In this condition, your immune system targets and attacks your hair follicles, triggering inflammation that disrupts their normal functioning. This leads to one or more patches of partial or complete hair loss.
It is estimated that about two percent of people worldwide will experience alopecia areata at some point in their lives. In the United States, approximately 700,000 people are currently living with some form of this condition, according to the National Alopecia Areata Foundation.
While alopecia areata can start at any age, it most often develops early in life. Over 80 percent of those with the condition are affected before the age of 40, and 40 percent develop symptoms by the time they are 20.
To understand the symptoms of alopecia areata, it helps to break down its name: alopecia means hair loss and areata means occurring in patches. Together, these terms describe the characteristic feature of the condition — patchy hair loss.
There are three main forms of alopecia:
Alopecia areata. The most common form, which is characterized by one or more small, roundish patches of hair loss on the scalp or other areas of the body.
Alopecia totalis. This form involves complete or near-complete loss of hair from your scalp.
Alopecia universalis. A rarer form of alopecia that leads to total or near-total hair loss on the scalp, face, and body, including eyebrows and eyelashes.
Alopecia totalis and universalis represent five to ten percent of cases, with alopecia areata making up the majority.
The primary symptom of alopecia areata is hair loss in round or oval patches on the scalp. These patches usually develop over a few weeks and may range from a single spot to multiple areas of hair loss. The affected skin in these patches is typically smooth and appears normal, with no visible sign of inflammation.
Some individuals may experience certain sensations on their scalp, such as itching, burning, or tingling, before hair falls out.
In addition, if you look closely at the edges of an alopecia areata patch, you may notice “exclamation point” hairs. These are hairs that look thinner at their base than they do at their tip.
The course of alopecia areata is unpredictable and can vary widely among individuals. It can progress in several ways:
Hair can regrow spontaneously within a few months — though relapses are not uncommon and may occur even years later.
Additional patches of hair loss may occur, often while hair is growing back in older patches.
Patches may join together to form a larger area of hair loss.
Uncommonly, alopecia areata may progress to complete loss of hair from the scalp (alopecia totalis) or from both the scalp and body (alopecia universalis).
Nail changes can also occur in alopecia areata. About 30 percent of people experience nail changes, including pitting, ridging, roughness, and/or brittleness.
Alopecia areata is an autoimmune disease, meaning it occurs when the immune system mistakenly attacks healthy tissue. In the case of alopecia areata, the immune system specifically targets hair follicles, and in some cases, the nails.
Let’s look further into the causes and pathogenesis (how it develops and progresses) of alopecia areata.
Alopecia areata is a complex condition. Any one case likely has multiple causes and triggers, including genetic predisposition, environmental triggers, and autoimmune mechanisms. While the exact cause is not fully understood, researchers have identified several factors and processes that contribute to the development of the disease.
The hair follicle is normally an immune-privileged site, meaning it’s largely shielded from the body’s immune system and inflammatory responses. However, in alopecia areata, this protection is disrupted, allowing immune cells to get to the area around the hair follicles. This triggers inflammation and interferes with the follicles’ normal function.
Researchers don’t completely understand what causes the disruption in immune privilege and the immune system to turn on the hair follicles. However, it’s believed that both genetic predisposition and environmental factors such as stress and infection play a role.
Usually, your hair follows a growth cycle that includes three phases:
Anagen, the growth phase
Catagen, a transitional phase where the hair growth slows
Telogen, a resting phase where no hair growth occurs, and hair eventually sheds in preparation for a new anagen phase
In people with alopecia areata, the autoimmune response shortens the anagen (growth) part of the hair cycle. This prevents affected hair follicles from staying in the growth phase long enough to produce fully developed hair. They prematurely enter the resting phase, resulting in hair being shed.
Anyone can get alopecia areata, but certain factors can increase your risk. Let’s explore these.
You may have asked yourself, “Is alopecia genetic?” The answer is that it can be — some cases of alopecia areata have a genetic component, but not all.
If you have a close family member affected by alopecia areata, you’re at a higher risk of developing it yourself. It is estimated that approximately 20 percent of individuals with alopecia areata have a family history of the condition.
Some research indicates that alopecia areata is more common in women than in men. A 2023 study of alopecia areata in the United States also suggested that it’s more common in people of color, especially Asian Americans.
You may also be more likely to develop alopecia areata if you have a personal or family history of certain health conditions. These include autoimmune disorders such as vitiligo, psoriasis, autoimmune thyroid disorders, or lupus, as well as atopic (allergic) conditions like atopic dermatitis (eczema), asthma, or hay fever.
Certain factors can be triggers for alopecia areata in genetically susceptible people. These include psychological stress and certain viral infections.
If you notice unexplained hair loss on your scalp or other parts of your body, especially if it’s happening in patches, it’s a good idea to make an appointment with a healthcare provider.
As we mentioned before, there are many types of hair loss. A healthcare provider can determine if your hair loss is due to alopecia areata or different kind of hair loss, such as female pattern baldness or telogen effluvium.
Below, we’ll discuss how alopecia areata is diagnosed.
In most cases, the diagnosis of alopecia areata is based on the pattern of hair loss, along with medical and family history. Your healthcare provider will start by getting your medical history and may ask about things like:
When you first noticed the hair loss
If you had any additional symptoms
Any other health conditions you may have
Whether or not you have a family history of hair loss or related conditions
They’ll then examine your scalp using a dermatoscope, a specialized magnifying tool. They’ll see how the affected area looks and whether there are signs of alopecia areata like exclamation point hairs. They may also check other areas of your body for additional hair loss and examine your nails to see if there are any changes commonly associated with alopecia areata.
Your healthcare provider may also perform a hair pull test, gently tugging on a few hairs to see how easily they come out.
If the diagnosis remains unclear, they may take a small skin biopsy to help confirm what’s causing your hair loss.
They may also do blood tests to check for thyroid disease or other underlying conditions may be recommended.
A dermatologist is the type of healthcare professional that treats hair loss, including alopecia areata. Treatment recommendations for alopecia areata depend on several factors, including:
The extent and location(s) of your hair loss
How long you’ve had alopecia areata
Which treatments you’ve tried previously
Associated symptoms or conditions
Your age
Let’s dive into the different alopecia areata treatments.
While there is no cure for alopecia areata, the good news is that this condition doesn’t damage hair follicles, so they retain their ability to regrow hair. Many people with alopecia areata will experience spontaneous regrowth — about 50 percent of affected people will regrow hair within a year of their first symptoms, even without treatment.
For mild cases involving just one or two small patches, your healthcare provider may recommend observation rather than immediate treatment, as hair often regrows on its own. However, it’s common for alopecia areata to come back, and it becomes harder to treat hair loss the longer it goes on.
Treatment options for mild to moderate patchy hair loss include:
Topical steroids or injected corticosteroids, which reduce inflammation around the hair follicles
Topical minoxidil, sold under the brand name Rogaine®, is available as a 2% solution or a 5% foam. This is often used in conjunction with corticosteroids.
Topical anthralin, an anti-inflammatory medication that’s also used for other skin diseases like psoriasis
Treatment options for more severe cases of patchy hair loss include:
Topical immunotherapy, which involves your provider regularly applying an irritant chemical to affected areas to provoke an allergic reaction. The aim is to “distract” the immune system from attacking the hair follicles.
Oral corticosteroids, which are sometimes used for more extensive or rapidly progressing hair loss, although they are not for long-term use.
JAK inhibitors are newer oral medications that target the immune response and work by reducing inflammation around the hair follicles. The three JAK inhibitors recently approved by the FDA to treat alopecia areata are Olumiant® (baricitinib), Litfulo® (ritlecitinib), and Leqselvi® (deuruxolitinib).
Treatment for alopecia areata will often involve combining therapies to improve the chances of success.
While some people with alopecia areata experience hair regrowth with treatment, others may not respond as well. In some cases, the condition can progress to more extensive hair loss over time. Factors such as the extent of initial hair loss, nail changes, or a family history of alopecia areata may increase the likelihood of more persistent or severe forms of the condition.
Having significant or widespread hair loss can be distressing and make you feel self-conscious. Research shows that alopecia areata can significantly impact quality of life, so it may be beneficial to engage with a mental health professional to help you work through the psychological impact of hair loss.
There are also a variety of cosmetic ways to help hide your hair loss, including:
Styling your hair to cover bald spots
Wearing a wig or hairpiece
Using artificial eyelashes
Trying out microblading, a type of semi-permanent tattoo, to fill in lost eyebrows
You may be wondering if you can prevent alopecia areata or, if you already have a diagnosis, how to stop alopecia areata from progressing.
There’s no way to prevent alopecia areata since it’s an autoimmune disorder that often has a genetic component. However, some steps may help reduce the chances of flare-ups or slow their progression.
There are a couple of things that you can do that may help you manage alopecia areata.
Stress management. Stress is thought to be a potential trigger for alopecia areata. Activities like meditation, exercise, and relaxation techniques may help reduce the risk of flare-ups.
Early intervention. If you notice signs of alopecia areata, such as small bald patches, consult a healthcare professional right away. Early treatment with medications like corticosteroids or other therapies may help reduce the severity of hair loss and encourage regrowth.
Avoiding triggers. While not always possible, try to identify and avoid factors that trigger flare-ups, such as intense stress or certain medications.
Healthy lifestyle. A nutritious diet, regular exercise, and good sleep hygiene support overall health and may help improve immune function. While these habits won’t prevent alopecia areata, they improve overall well-being.
If your alopecia areata appears to be worsening or expanding, consult your dermatologist. They can assess your condition and adjust your treatment plan as needed.
Have more questions about hair loss in general? Check out our guide to hair loss. You may also want to browse our hair care products, including products for hair loss.
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