Alopecia Areata: Causes, Symptoms, and Treatments
Hair loss can come in many forms, from a receding hairline to thinning around your temples or a diffuse loss of density across your entire scalp.
Many of these signs of hair loss are the result of male pattern baldness — a type of alopecia that develops due to a combination of genetic factors and the effects of dihydrotestosterone (DHT), a male sex hormone that’s produced from testosterone.
Because it’s caused by a mix of androgen hormones and genetic factors, this type of hair loss is often referred to as androgenetic alopecia.
Male pattern baldness is the most widespread form of hair loss in men, but it’s definitely not the only issue that can cause extensive hair loss.
If you notice that you’re beginning to develop patches of hair loss around your scalp and/or face, you’re most likely dealing with a type of hair loss called alopecia areata.
Alopecia areata is a form of patchy hair loss that can develop when your immune system targets and attacks your hair follicles. You may be at risk of this type of hair loss if you’re affected by an autoimmune disease, such as thyroid disease, vitiligo or psoriasis.
The good news is that alopecia areata is treatable, with several medications available to prevent shedding and help you stimulate hair regrowth.
Below, we’ve discussed what alopecia areata is, as well as the unique factors that may increase your risk of dealing with this type of hair loss.
We’ve also explained the symptoms of alopecia areata, as well as the treatment options that are available to control shedding, protect your hair follicles and promote healthy hair growth.
Causes of Alopecia Areata
Alopecia areata is a form of autoimmune hair loss that can cause you to develop small patches on your scalp and/or face without any hair.
Unlike male pattern baldness, which happens when DHT damages your hair follicles, or telogen effluvium, which can develop due to stress, infections or a nutritional deficiency, alopecia areata is caused by your immune system.
More specifically, your immune system can mistakenly identify harmless cells as dangerous and attack them.
This damage can cause your hair to shed, usually in coin-sized patches on your scalp, face and other areas of your body.
The exact cause of alopecia areata isn’t known. However, researchers have identified a variety of genetic and environmental risk factors that may play a role in its development.
These include:
Other autoimmune diseases and allergic conditions. Research shows that alopecia areata is more common in people with thyroid disease, vitiligo and psoriasis, as well as allergies such as hay fever.
Genetic risk factors. Experts have identified several genes that may play a role in the development of alopecia areata. You may have a higher risk of developing this form of hair loss if you have a family member who is also affected by this disease.
Emotional stress. Some evidence suggests that high levels of emotional stress might be involved in the development of alopecia areata. However, many people develop this form of hair loss without any emotional or psychological alopecia areata triggers.
Infections. Some researchers believe that alopecia areata may be triggered, at least in part, by specific viral infections, such as Epstein-Barr virus (EBV) and cytomegalovirus (CMV).
Currently, the most widely accepted explanation paints alopecia areata as a disorder of the hair follicle cycle.
When your inflammatory cells wrongly attack, they typically target hair follicles that are in the anagen stage of the hair growth cycle. This is the first stage of your hair’s natural cycle, when the hair follicles start to produce new hairs that gradually grow to their full length.
This attack can push your hair follicles into the second phase of the natural hair growth cycle, which is referred to as the catagen phase, early.
Following this, your hair follicles are pushed into the telogen phase, during which each follicle rests and stops active hair growth. During this phase, the club hair — a hair strand with a firm, club-shaped structure at its base — sheds from your scalp.
By attacking your hair follicles during this process, your immune system can weaken the hair shaft — the visible part of your hair that grows out from your scalp. This can cause your hair to break, leaving you with visible bald patches with thin hair and little hair growth.
One good aspect of alopecia areata is that while your hair follicles are attacked and damaged by your immune system, the stem cells from which new hair grows are left unaffected.
This means that when alopecia areata is treated properly, it usually doesn’t result in the kind of permanent hair loss that’s common with male pattern baldness.
Types of Alopecia Areata
Alopecia areata can vary significantly in type and severity. Some types of alopecia areata can cause random bald spots on your head, while others cause severe hair loss that may affect all of your scalp.
There are three major types of alopecia areata:
Alopecia areata, or “patchy alopecia areata.” This type of alopecia areata involves hair loss in one or more coin-sized patches on your scalp, face or other areas of your body. It’s the most common type of alopecia areata.
Alopecia totalis. This type of alopecia areata causes total or near-total hair loss that affects your scalp. You may notice that your hair looks extremely thin and falls out en masse, leaving you with little or no scalp hair.
Alopecia universalis. This type of alopecia areata causes total or near-total hair loss on your scalp, face and across your entire body. Alopecia universalis is less common than other types of alopecia areata.
There are also several subtypes of alopecia areata. These include ophiasis, in which hairs shed in a band-like pattern around the rear and sides of the scalp, and sisaipho, in which most loss of hair occurs around the periphery of the scalp.
Another subtype of alopecia areata is Marie Antoinette syndrome, or canities subita, which can involve diffuse hair loss coupled with a sudden graying of your hair.
Symptoms of Alopecia Areata
Alopecia areata is a non-scarring form of hair loss, meaning it generally doesn't cause permanent follicular damage or lead to blemishes on the parts of your body that are affected. However, it can cause some noticeable symptoms, including:
Small round or oval-shaped patches of hair loss on your scalp
Patchy hair loss and broken hairs in your eyebrows, eyelashes and/or facial hair
Areas with significant hair loss on your body, such as your abdomen and/or limbs
Complete loss of hair as small patches of hair loss form into large hairless areas
Changes in your fingernails and toenails, including ridges and pits
The extent of hair loss from alopecia areata can vary. For some people, it involves small areas of hair loss on the scalp, while for others, it’s a more severe condition that involves patchy hair loss on the scalp, face and body.
When severe, alopecia areata can have more than just an aesthetic effect — it can also have a severe negative impact on your self-confidence, mental health and general quality of life.
Most of the time, hair loss from alopecia areata eventually grows back. You may be more likely to experience regrowth of hair if you have mild alopecia, develop alopecia areata relatively late in life, don’t experience any nails changes, or have no family history of forms of hair loss.
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Treatments for Alopecia Areata
While there’s currently no cure for alopecia areata, this form of hair loss is usually treatable. Mild cases of alopecia areata often get better on their own with time, while moderate to severe cases often improve with medication.
If you think you may have alopecia areata, it’s important to talk to your primary care provider or schedule an appointment with a dermatologist.
To diagnose this type of hair loss, your healthcare provider may complete a physical exam, with a focus on your scalp and nails. You might be asked about how long your symptoms have been occurring, or if you have any family members with a similar pattern of hair loss.
If appropriate, your healthcare provider might prescribe medication to control damage from your immune system and stimulate hair regrowth.
Common treatments for alopecia areata include:
Topical corticosteroids. These medications are applied directly to your skin to control inflammation. Your healthcare provider may prescribe a corticosteroid to suppress your immune system and reduce inflammation in your scalp.
Intralesional steroids. These medications are injected directly into your skin to reduce the severity of alopecia areata. This type of medication is considered the most effective form of treatment for patchy alopecia areata.
Topical immunotherapy. This type of treatment involves applying contact allergens to your scalp to produce an immune system reaction. A variety of allergens are used for this treatment, including dinitrochlorobenzene (DNCB) and diphencyprone (DPCP).
Minoxidil. This medication can stimulate hair growth by moving your hair follicles into the anagen, or growth, phase of the hair growth cycle. Using minoxidil may speed up hair growth after your scalp recovers from alopecia areata inflammation.
We offer several hair loss medications, such as minoxidil and finasteride, as part of our range of men’s hair loss treatments.
You may wonder if there are certain habits to avoid with alopecia areata. In addition to using medication, you may benefit from making changes to your lifestyle to reduce the severity of alopecia areata and prevent your symptoms from getting worse.
For example, it’s often helpful to use sunscreen to protect areas of your skin with noticeable hair loss from UV damage, which may damage your scalp or face. Wearing a hat, sunglasses and/or bandana can shield your skin from UV-related damage if you have little or no hair coverage.
For more, read our blog on how to stop alopecia areata from spreading.
If you feel stressed, anxious or depressed due to alopecia areata, it’s also important to talk to a mental health professional.
You can connect with a mental health provider from your home using our online mental health services, allowing you to easily access support and ongoing care.
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No matter the treatment plan, the best place to start is somewhere. Early action is the best hair loss prevention.
The Bottom Line on Alopecia Areata
Alopecia areata is significantly less common than male pattern baldness, but it’s still important to be aware of its symptoms and seek help if you notice any of them developing.
The biggest sign of alopecia areata is a patchy look to your hair loss that’s easy to differentiate from the receding hairline or diffuse thinning that defines androgenetic alopecia.
If you have alopecia areata, your healthcare provider will likely suggest using medication, such as a corticosteroid, to reduce inflammation and protect your hair follicles. Make sure to closely follow your healthcare provider’s instructions and let them know if you have any side effects.
Worried you may have another form of hair loss? We offer a wide range of hair loss treatments online, including evidence-based, FDA-approved medications for male pattern baldness.
You can get started today by taking part in an online consultation for hair loss, or find out more about your options with our guide to the best treatments for thinning hair.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment or medication.