What is alopecia areata?
This is a disease that develops when the body attacks its own hair follicles (where hair grows from), which can cause hair loss anywhere on the body.
Contagious: No
Pronounce: alopecia (al-low-pee-she-ah) areata (air-ē-ah-ta)
Bald patch
Many people who develop alopecia areata develop a round or oval bald patch on their scalp.
Many people who develop alopecia areata are otherwise healthy. They have hair loss and sometimes nail changes, but they remain in good health.
The hair loss tends to be unpredictable. Hair may regrow without treatment. This happens more often when someone has a few bald patches. When the hair regrows, it may fall out again—or it may not.
If alopecia areata affects the nails, you may see dents, ridges, or brittle nails. Some people develop red nails.
When does alopecia areata usually begin?
It can begin at any age; however, most people develop it during childhood or their teenage years. About half them see their hair regrow within 12 months without treatment.
When the hair regrows, it may never fall out again. It’s also possible to have unpredictable cycles of hair loss and regrowth for years.
If a parent has alopecia areata, will a child get it?
If a parent or close blood relative has (or had) alopecia areata, a child has a greater risk of developing this disease. While the risk is greater, not every child with this increased risk will get alopecia areata.
Research leading to new treatment
Because hair loss can greatly affect a person’s quality of life, researchers continue to study alopecia areata. Much of this research focuses on developing more effective treatments. This is giving new hope to patients, especially those living with widespread hair loss.
Dermatologists are conducting much of this research. If you are an adult with widespread alopecia areata, your dermatologist may talk with you about the possibility of joining one of these studies.
Types of alopecia areata
When talking about treatment, your dermatologist may mention the type of alopecia areata that you have.
The main types are:
Alopecia areata: Alopecia is the medical term for bald. Areata means patchy. This patchy baldness can develop anywhere on the body, including the scalp, beard area, eyebrows, eyelashes, armpits, inside your nose, or ears.
Alopecia totalis: The person loses all hair on the scalp, so the scalp is completely bald.
Alopecia universalis: The person loses all hair, leaving the entire body hairless. This is rare.
What are the signs and symptoms of alopecia areata?
While alopecia areata often causes hair loss on the scalp, you can have hair loss on any part of your body. Some people develop hair loss on another area of the body, such as the eyelashes, eyebrows, or beard area (men only). Wherever the hair loss occurs, it happens without any signs of a rash, redness, or scarring.
A common sign of alopecia areata
The first sign of alopecia areata is often a round or oval bald patch on the scalp.
Pictures of alopecia areata
The following pictures show several ways this disease can cause hair loss, and how it can affect your nails. As you look at these pictures, notice that the affected skin often looks like someone shaved the area completely bald.
Beard affected by alopecia areata
Men who have alopecia areata may develop one or more bald patches in their beard area.
Hair loss due to alopecia areata
While hair loss on the scalp often causes round or oval bald patches, hair loss can take any shape.
Alopeica areata can cause a band of hair loss
Some people develop a band or strip of bald skin on their scalp, which is called ophiasis (oh-fee-ah-sis).
Widespread hair loss
Alopecia areata can also cause widespread hair loss, leaving a person with little hair on the head, and some people lose all the hair on their head.
Loss of eyelashes
Alopecia areata can cause partial or complete loss of eyelashes, eyebrows, or both.
Red nails
About 10% to 20% of people who have alopecia areata see changes to their nails, which can include red nails (shown here), pits in the nails, ridges that run the length of the nails, or nails that become so rough they feel like sandpaper.
Brittle nails
People who have a lot of hair loss can develop brittle nails that split.
Alopecia areata rarely causes symptoms
The only sign of alopecia areata is often sudden hair loss. The patches of hair loss can grow larger. Sometimes, the patches grow larger and become one large bald spot.
Other signs that you may have alopecia areata include:
Gray and white hairs often remain where you have hair loss
Hair starts to regrow on its own where it fell out
Hair begins growing in a bald spot and starts falling out in another area
Hair loss occurs during a colder month of the year
Cold may be a trigger for alopecia areata. In one study, researchers noticed that people diagnosed with alopecia areata most often had hair loss in November, followed by October and January. Patients had the fewest flare-ups during May and August.
If you have alopecia areata, it generally doesn’t cause pain or other symptoms. However, some people say that right before they lose their hair, they feel tingling, itching, or burning on the skin where the hair will fall out.
If you have alopecia universalis, which causes complete loss of hair everywhere on your body, your nails can become extremely brittle and crack. This can be painful.
What causes alopecia areata?
Alopecia areata is an autoimmune disease. This means that your immune system mistakenly attacks a part of your body.
When you have alopecia areata, cells in your immune system surround and attack your hair follicles (the part of your body that makes hair). This attack on a hair follicle causes the attached hair to fall out.
The more hair follicles that your immune system attacks, the more hair loss you will have.
It’s important to know that while this attack causes hair loss, the attack rarely destroys the hair follicles. This means that your hair can regrow. The less hair loss you have, the more likely it is that your hair will regrow on its own.
Can a vitamin D deficiency cause alopecia areata?
Studies have found that people with certain autoimmune diseases, such as multiple sclerosis or rheumatoid arthritis, have a vitamin D deficiency.
Because alopecia areata is an autoimmune disease, scientists have looked at the vitamin D levels in people who have alopecia areata. Some people did have a vitamin D deficiency, but others didn’t. More research is needed before we know whether low levels of vitamin D play a role in causing this disease.
Who gets alopecia areata?
While anyone can get alopecia areata, some people have a greater risk of developing it. Those most likely to get it have:
A close blood relative with alopecia areata: It’s estimated that about 10% to 20% of people with alopecia areata have a family member who has it. Because many people try to hide hair loss, this percentage may be higher.
Asthma, hay fever, atopic dermatitis, thyroid disease, vitiligo, or Down syndrome: Research shows that people who have one of these diseases are more likely to get alopecia areata.
Been treating cancer with a drug called nivolumab: While it’s too early to say whether this greatly increases your risk, a few cancer patients who received a drug called nivolumab (nye-VOL-you-mab) have developed alopecia areata. The drug is used to treat lung cancer and melanoma that has spread. Hair loss usually begins a few months after they start treatment. It’s called nivolumab-induced alopecia areata, and the hair loss is considered a good sign. This type of hair loss usually means that the drug is working.
Your race may also affect your risk of getting alopecia areata. In a large study, researchers found that black and Hispanic nurses were more likely than non-Hispanic white nurses to develop this disease.
While this study spanned several years, it has many limitations. For example, it only looked at women nurses in the United States. More research is needed to know whether this finding holds true for other people.
When does alopecia areata begin?
You can get alopecia areata at any age; however, most people develop it by 30 years of age. For many, the disease begins during childhood or the teenage years.
Alopecia areata often begins before your 30th birthday
Alopecia areata often develops during childhood or the teenage years.
Is alopecia areata curable?
It cannot be cured; however, it’s possible to regrow hair. For some people, regrowth will happen without any help. Because alopecia areata cannot be cured, people who have regrowth can have more hair loss later. Some people have cycles of hair loss and regrowth.
If your hair doesn’t regrow on its own, medical treatments may help.
Dermatologist examining a patient with hair loss
To find out what's causing your hair loss, a dermatologist may use a tool called a dermascope to get a closer look.
Many things can cause hair loss. To provide you with the right treatment, it’s essential to know what’s causing your hair loss.
Dermatologists have expertise in diagnosing hair loss and counseling their patients on what may help them regrow their hair.
How do dermatologists diagnose alopecia areata?
Your dermatologist will examine the area(s) with hair loss carefully and look at your nails. Your dermatologist will also ask some questions. This may be enough to diagnose you.
Because there are so many reasons for hair loss, testing is sometimes necessary to make sure alopecia areata is the cause of your hair loss.
A blood test can look for other diseases caused by the immune system. Sometimes, other tests are necessary.
If you have alopecia areata, your dermatologist will talk with you about how the disease is affecting your life and whether treatment is recommended.
How do dermatologists treat alopecia areata?
If you just received your diagnosis and have had alopecia areata for less than a year, your dermatologist may recommend a wait-and-see approach. Your hair may regrow on its own, making treatment unnecessary.
When treatment becomes necessary, your dermatologist will consider many factors, including:
Your age
The amount of hair loss you have
Where you have hair loss
It’s important to know that no one treatment works for everyone. To find one that helps, you may need to try a few types of treatment or different medications. Here’s what your dermatologist may recommend.
Children 10 years of age and younger
Alopecia areata often begins during childhood. If your child has difficulty coping with the hair loss, treatment can often help regrow hair.
Treatment options for children 10 years of age and younger are:
Corticosteroid you apply to the bald spots: Prescription-strength corticosteroids can help regrow hair. You apply this medication once or twice a day. For children, this alone can be an effective treatment.
Minoxidil: Also known by the brand name Rogaine®, minoxidil can help maintain the regrowth after you stop applying the corticosteroid. It has few side effects, so it’s considered a good option for children.
For children older than 10 years of age, treatment options are based on the amount of hair loss.
Patchy alopecia areata
If you are older than 10 years of age and have a few patches of alopecia areata, your dermatologist may recommend one or more of the following treatments:
Injections of corticosteroids: To help your hair regrow, your dermatologist will inject this medication into the bald areas. These injections are usually given every 4 to 8 weeks as needed, so you will need to return to your dermatologist’s office for treatment.
Minoxidil: Also known by the brand name Rogaine®, minoxidil can help you keep the hair growth stimulated by another treatment. You will need to apply it 2 to 3 times a day. It’s helpful for the scalp, beard area, and eyebrows.
Corticosteroids you apply: You apply this medication to the bald spots once or twice a day as instructed by your dermatologist. This medication tends to be less effective in adults than in children for hair regrowth.
Anthralin: You apply this medication to the bald spots, let it sit on the skin for as long as your dermatologist says, and then wash it off. It will cause some skin irritation. To get the best results, you’ll also use minoxidil.
Loss of eyelashes
Our eyelashes protect our eyes. If you lose some (or all) your eyelashes, your dermatologist may include one or more of the following in your treatment plan to help protect your eyes:
False eyelashes
Glasses: Wearing glasses helps to protect your eyes and make the hair loss less noticeable.
Bimatoprost (or a similar medication): This is a prescription medication that’s approved to treat a type of glaucoma and high eye pressure. The U.S. Food and Drug Administration (FDA) has also approved it to help eyelashes grow longer.
Loss of eyebrows
If alopecia areata causes you to lose your eyebrows, your dermatologist may recommend one of the following:
Stick-on eyebrows
Semi-permanent tattoo
Intralesional corticosteroids: A dermatologist can inject this medication to help the eyebrows start growing again. If the injections work, applying minoxidil (also known as Rogaine®) as directed may help you keep the regrowth.
Lots of (or rapid) hair loss
When alopecia areata causes widespread hair loss, complete loss of hair on the scalp (alopecia totalis), or loss of all hair (alopecia universalis), few people regrow their hair without help.
If you have this type of hair loss, your dermatologist may recommend:
Contact immunotherapy: Also called topical immunotherapy, the goal of this treatment is to change your immune system so that it stops attacking your hair follicles. Dermatologists have:
Used this treatment for more than 30 years to treat widespread alopecia areata
Found that about 60% to 70% of patients have some hair regrowth
If this is an option, you will need to return to your dermatologist’s office weekly for treatment. It’s important that you keep every appointment. Missed appointments can cause this treatment to stop working, causing the regrown hair to fall out.
The treatment itself involves your dermatologist (or nurse) applying a chemical to your bald skin. The first time you receive this treatment, a small amount will be applied so that your body can start to develop a reaction to the chemical.
Once you develop a reaction, the chemical will be applied weekly to your bald areas and left on for 48 hours. During this time, you must keep the treated skin covered and should develop a rash, complete with redness, swelling, and itch. This rash lasts about 36 hours.
Contact immunotherapy is given weekly until you completely regrow your hair or the treatment fails to regrow any hair within 6 months.
To increase the effectiveness of this treatment, your dermatologist may prescribe another treatment that you use at home.
Methotrexate: If you have extensive hair loss and other treatments have not worked, this medication may be an option. In looking at studies of patients who have taken methotrexate to treat alopecia areata, dermatologists have found the following :
In a small study of patients who had complete loss of hair on their scalp or entire body, 57% had complete regrowth with methotrexate.
If this medication works for you, you should see some regrowth in about 3 months after you begin taking it.
If methotrexate fully regrows your hair, regrowth will take 6 to 12 months.
Your dermatologist may prescribe methotrexate alone or along with a medication called a corticosteroid. Taking methotrexate and a corticosteroid, such as prednisone, can improve results.
Methotrexate has possible side effects, some of which can be serious or life-threatening. Before starting methotrexate, talk with your dermatologist about possible side effects.
Corticosteroid you take: Taking this medication for about 6 weeks can help regrow hair. In a study of 32 patients with widespread alopecia areata, many had some regrowth after taking prednisone (a type of corticosteroid) for 6 weeks.
While this medication can help regrow hair, it cannot be taken for long. Serious side effects can develop. It’s also possible that when you stop taking this medication, your new hair will fall out.
Medication (JAK inhibitors): The discovery that this type of medication can treat extensive hair loss in people who have alopecia areata is a major research breakthrough. The JAK inhibitors that have been studied include tofacitinib, ruxolitinib, and baricitinib.
While these medications help some patients when nothing else works, the patient’s hair often falls out when the medication is stopped. For this reason, studies are looking at other possibilities, such as taking this medication for a longer time or making the medication into one that you can apply to bald skin.
Wig, hairpiece, or scalp prosthesis: Your dermatologist may recommend this option for a few reasons. Treatment takes time, and a wig or hairpiece can cover up hair loss right way. This is important if hair loss has lowered your self-esteem or is causing you to feel anxious or depressed. Treatment also has possible side effects. To avoid these, some people prefer to cover up their hair loss. It’s also possible that treatment may not work.
What exactly is a scalp prosthesis?
This is a wig that’s custom-made to help ensure a perfect fit. Other names for a scalp prosthesis are:
Hair prosthesis
Cranial prosthesis
All wigs are usually held on with a wig cap, such as the one this woman is wearing.
Shaving the head or beard: This can hide patchy or diffuse hair loss on the head or beard area.
Your dermatologist may talk with you about a treatment not mentioned here. There are many treatments for alopecia areata, but no single treatment has been shown to work for everyone.
What is the outcome for someone who has alopecia areata?
Sometimes, hair regrows on its own without treatment. This happens more often when someone has a few patches of alopecia areata, which have been there for less than 1 year.
When hair fails to grow back, treatment can help.
Most people with alopecia areata are otherwise healthy
The hair loss is never a sign of cancer.
Things you can do to help gain control over alopecia areata
Alopecia areata is a medical condition that can affect many areas of your life. The following may help you feel better:
Understand that many people who have alopecia areata are otherwise healthy. Many patients confess that when they first noticed patches of hair loss, they tried to hide them. They didn’t want to tell anyone and hoped their hair would grow back. Their bald patches also left them wondering whether they had cancer or another life-threatening disease.
Having alopecia areata is not a sign of cancer. In fact, many people who have alopecia areata are otherwise healthy.See a specialist who has expertise in managing alopecia areata, such as a board-certified dermatologist. When you see a board-certified dermatologist, you see a doctor who has the training, knowledge, and expertise necessary to diagnose and treat hair loss.
A dermatologist can work with you to find the treatments best suited to help you. It’s important to understand that sometimes your dermatologist will recommend a wait-and-see approach. If you have a few patches of hair loss, it’s possible that your hair will regrow on its own.
Dermatologists can also give you self-care tips that can help if you lose your eyelashes, eyebrows, the hair inside your ears, or hair on other areas of your body.
Mention nail changes to your dermatologist. Alopecia areata can cause changes to your nails, too. If you notice a change to your nails, tell your dermatologist. If nails changes worsen, you may start to feel pain. Some nail changes can interfere with everyday activities, such as typing or playing an instrument. Your dermatologist can tell you whether you need to treat your nails.
Protect affected areas from cold temperatures. Hair loss on your scalp, inside your ears, or in your nose can make you extremely sensitive to the cold. Keep warm with hats and scarves.
Apply antibiotic ointment if you have lost nose hairs. Your nose hairs keep out dust, germs, and small airborne particles. If you lose your nose hair, dermatologists recommend applying antibiotic ointment just inside each nostril to keep out small particles.
Safeguard your eyes if you lose eyebrows or eyelashes. If you lose hair in either area, here’s what you can do to protect your eyes:
Wear false eyelashes
Apply stick-on eyebrows
Wear glasses to protect your eyes
Cover up to protect your scalp. If you lose hair on your scalp, protect your skin by applying sunscreen or putting on a hat before you go outdoors. This will reduce your risk of getting sunburn and skin cancer. It will help your skin feel more comfortable.
Try to avoid getting stressed out. When you have alopecia areata, you can experience unexpected hair loss and regrowth. Many people living with this disease say that before a cycle of hair loss, they often feel stressed out. Learning how to manage your stress with a technique that works for you, such as meditation or yoga, may help reduce cycles of hair loss.
Get physicals as often as your dermatologist recommends. While many people who have alopecia areata are otherwise healthy, you do have a higher risk of getting some other diseases, such as thyroid disease. The earlier these diseases are found, the easier they are to control.
Realize that many people have trouble coping with the emotions that can unexpectedly arise with hair loss. Many people who have alopecia areata confess that their hair loss makes them feel all alone, lowers their self-esteem, or makes them feel sad and anxious. If you have these feelings, help is available. The resources on this page can help: Alopecia areata and emotional wellness (NAAF website).
Connect with others who have alopecia areata through the National Alopecia Areata Foundation (NAAF). On its website, it says, “NAAF was established with one clear goal: To offer support to individuals affected by alopecia areata.”
Today, NAAF offers a Support Group Program, the ability to speak one-on-one via phone with an experienced support contact, and a mentoring program for children living with alopecia areata. You’ll find these resources at: Support (NAAF website)
If you're looking for a permanent solution to your hair loss, you may want to consider a hair transplant
Hair transplant surgery allows the surgeon to move healthy hairs on your scalp to areas with thinning hair.
Today, it’s possible to have natural-looking results thanks to one key advance. Most surgeons now transplant the healthy hairs a few at a time. This eliminates the unnatural doll-like hair that patients saw in the 70s and 80s. Back then, sections of hair called hair plugs were placed in the thinning area. In time, the hair plugs became quite noticeable.
Improvements in creating the hairline and placing the hairs in the thinning areas also help create natural-looking results.
Thanks to these advances, the results can look so natural that a barber or stylist cannot tell you’ve had anything done.
Results depend largely on the surgeon you select
While these advances are giving patients natural-looking results, the outcome still depends largely on the surgeon you select. You want to choose a doctor who understands hair loss and performs hair transplants regularly.
Dermatologists specialize in conditions that affect our skin, hair, and nails, so they know a lot about hair loss. Many also perform hair transplants and can tell you whether you are a good candidate for a hair transplant.
Who is a good candidate for a hair transplant?
Are you a man in your 20s, who is experiencing hair loss? For best results, you may be asked to wait to have a hair transplant and start treating with a hair loss medicine.
Men and women of all races can be good candidates for a hair transplant.
To be considered for a hair transplant, you need two things:
Enough healthy hair on your scalp that can be transplanted to the area that needs hair
The ability to grow hair on the thinning area of your scalp
During a consultation with a dermatologist, you can find out if you have both. A dermatologist will give you a thorough scalp exam.
To find out why you have hair loss, you may also need a blood test. This can check for things going on in your body that may be causing your hair loss. Some patients need a procedure called a scalp biopsy. Your dermatologist can quickly and easily take what is needed for the scalp biopsy during the consultation.
If the exam and tests show that you are a good candidate for a hair transplant, your dermatologist can tell you what results you can expect. A full head of hair may be unrealistic, but a fuller head of hair can be the goal.
What happens during a hair transplant?
You can expect a hair transplant to take between four and eight hours. If you are having a large amount of hair transplanted, you may need to return for a few hours the next day.
Most patients remain awake during the entire surgery and need only an anesthesia that makes the scalp numb. Some patients also take a mild sedative to help them relax.
Hair transplant surgery usually lasts between 4 and 8 hours.
The surgery begins with your dermatologist removing the healthy hairs. To give you natural-looking results, your dermatologist may remove the healthy hairs by either cutting a strip of skin with healthy hairs from your scalp or removing individual hairs.
The second option takes a lot more time, but avoids leaving a long, narrow scar on your scalp. This can be beneficial if you prefer close-shaven haircuts like buzz cuts.
Before the surgeon can transplant the hairs, technicians need to prep the removed hairs and the surgeon must get your scalp ready for the transplant.
Depending on the number of hairs to be transplanted, two to three members of the hair transplant team may help place the healthy hairs into the area that needs hair. Once all the hairs have been transplanted, your scalp will be bandaged and you will be given instructions for at-home care.
When do patients see results from a hair transplant?
Most patients see results between six and nine months after surgery. For some patients, it takes 12 months.
It’s important to know that between two and eight weeks after the surgery, the transplanted hair will fall out. This is normal. By the third month, the hair may look thinner than before you had the transplant. Again, this is normal.
Medicine can help you keep the results
To get the best results from a hair transplant, your dermatologist may recommend medicine that treats hair loss. Medicine helps because hair loss and thinning can continue, even after a hair transplant.
Medicine can prevent or slow down new hair loss and thinning. By doing that, you can keep your natural-looking results for years to come.
HAIRSTYLES THAT PULL CAN LEAD TO HAIR LOSS
A sleek ponytail, cornrows, or tightly pulled updo can look great. If you wear your hair tightly pulled back often, the constant pulling may eventually lead to hair loss. By making a few changes, you can keep your sense of style without losing your hair.
Changes that help prevent hair loss due to tight hairstyles
Anyone who frequently wears a tightly pulled hairstyle can develop hair loss. In fact, there’s actually a medical term for this type of hair loss. It’s called traction alopecia (al-oh-pee-sha).
You can reduce your risk of developing this type of hair loss by following these dermatologists’ tips.
Avoid frequently wearing hairstyles that pull on your hair. Every once in a while, it’s OK to wear your hair tightly pulled back, but you want to avoid wearing a tightly pulled hairstyle every day. The constant pulling can cause strands of your hair to break or fall out.
Buns, ponytails, and up-dos that are tightly pulled
Cornrows
Dreadlocks
Hair extensions or weaves
Tightly braided hair
Wearing rollers to bed most of the time can also lead to hair loss, so dermatologists recommend styling your hair this way only on special occasions.
Avoid wearing hairstyles that pull on your hair
If you often wear your hair tightly pulled back, the first sign of hair loss may be broken hairs around your hairline or thinning hair where your hairstyle pulls tightly.
Loosen up the hairstyle. When you wear your hair pulled back, loosen the hairstyle a bit, especially around your hairline. To reduce the constant pulling, you can:
Loosen braids, especially around your hairline
Wear a braided style for no longer than two to three months
Opt for thicker braids and dreadlocks
Loosen up your hairstyle
If your hairstyle feels painful, the style is too tight.
Change it up. Changing hairstyles can also help reduce the pull. Ideally, when you change styles, you want to give your hair a chance to recover. For example, after wearing cornrows, you may want to wear loose braids or go natural for a few months.
Cornrows
Cornrows, which pull at the roots of your hair, can cause hair loss. Wearing looser braids and changing your hairstyle after 2 or 3 months can prevent hair loss.
Follow these precautions when wearing a weave. Weaves and extensions are great way to add volume and length to your hair. To prevent them from causing hair loss, dermatologists recommend that you:
Wear them for short periods of time, as the pulling can increase your risk of developing traction alopecia
Remove them immediately, if they cause pain or irritate your scalp
Opt for sewn-in weaves rather than ones that use bonding glue
Have a professional relax your hair. A hairstylist who has training in chemical relaxers can chose the product that will achieve the results you want while minimizing the damage to your hair.
Look for early signs of hair loss. If you wear hairstyles that pull tightly, take time every month to look for these early signs of hair loss:
Broken hairs around your forehead
A receding hairline
Patches of hair loss where your hair is pulled tightly
If you see any of the above, it’s time to stop pulling on your hair so that your hair can regrow.
Change your hairstyle immediately if you notice any of the following problems. These are signs that your hairstyle or products could cause hair loss:
Pain from tightly pulled hair
Stinging on your scalp
Crusts on your scalp
Tenting (sections of your scalp are being pulled up like a tent)
When to see a board-certified dermatologist
If you have hair loss, it’s never too early to see a board-certified dermatologist. People develop hair loss for many reasons. Your hairstyle may be the cause. It’s also possible that something else is causing your hair loss, such as stress or hereditary hair loss. A board-certified dermatologist can get to the root of the problem.
The sooner you find out what’s causing your hair loss and take steps to stop it, the better your results.