Alopecia areata

Published by Bupa's Health Information Team, September 2010.

This factsheet is for people who have alopecia areata, or who would like information about it.

Alopecia areata causes inflammation of the hair follicles leading to hair loss. The amount of hair lost can vary. There are a number of treatments available, although the condition usually gets better on its own.

About alopecia areata

Alopecia areata affects your hair follicles, causing patches of baldness. You may find that your hair grows back, although this can take months or years. The hair that grows back may be white, at least at first. It doesn't permanently damage your hair follicles, so even if you have hair loss in any one area for a long time, your hair may still be able to grow back.

About one or two people in 1,000 in the UK have alopecia areata. The condition can develop at any age but it's most common in young people aged between 15 and 29 - six out of 10 people with alopecia get it under the age of 20. It affects men and women equally.

Alopecia areata is a chronic, inflammatory condition. A chronic condition is one that lasts a long time, sometimes for the rest of your life. When describing an illness, the term chronic is about how long you have it, not how serious it is.

Alopecia areata doesn't harm your health in any other way.

Symptoms of alopecia areata

Some of the main symptoms of alopecia areata include the following:

• You may have patchy hair loss that appears as small, round areas of baldness. These areas are most likely to be on your scalp, although they may also occur on your eyebrows, eyelashes or beard.
  
• Usually the exposed skin will look smooth and healthy, but occasionally it can be red or scaly.
  
• You may have short, broken hairs at the edges of the bald patches. These are called exclamation hairs and are tapered at the end nearest to your head.
  
• Your nails may be pitted or split, or have grooves running across them.

Alopecia areata

Complications of alopecia areata

If you have alopecia areata, you may be more likely to get autoimmune conditions such as thyroid disease and vitiligo. Autoimmune conditions are caused by your immune system attacking your body.

Sometimes alopecia areata can progress to the loss of all the hair from your scalp (alopecia totalis). It's very rare that you will lose all your body hair (alopecia universalis). The more hair you lose, the less likely it is that the condition will completely go away.

Causes of alopecia areata

It isn't fully known why some people develop alopecia areata. It is an autoimmune disease, which means your body's immune system mistakenly attacks your hair follicles. This reaction prevents new hair from forming and causes existing hair to fall out.

About one in five people with alopecia areata have a family member who also has the condition. This suggests that alopecia areata may be genetic. Genes are found in every cell in your body and carry the codes that determine your characteristics such as your hair and eye colour. You inherit your genes from your parents. It's possible that having a certain combination of genes makes you more likely to develop alopecia areata, although other factors also probably play a part.

If you have another condition that involves your immune system such as eczema or are prone to allergies, you may be more at risk of alopecia areata.

Diagnosis of alopecia areata

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. If there is a possibility that you may have other autoimmune conditions, you may have blood tests.

Your GP might refer you to a dermatologist (a doctor who specialises in skin conditions), if more than half your hair is missing and there are no signs of regrowth.

Treatment of alopecia areata

In three to five out of 10 people, the hair grows back within a year without any treatment.

There are a number of treatments that you may want to try, although their effectiveness varies for everyone. Some treatments for alopecia areata may encourage your hair to grow back, although none of these can completely cure the condition.

Self-help

If you have mild alopecia areata, you may decide not to have any treatment. Your GP may suggest that you wait for up to three months to see whether your hair grows back without treatment.

You may choose to wear a hat or a bandana. Wigs may also be an option. These can be of human or synthetic hair. Ask your GP for more advice about where you can get wigs.

Your hair usually provides some protection from the sun to the skin on your head. If you have alopecia, apply a sunscreen to the areas of hair loss if you are outside in sunny weather. Make sure you use a broad spectrum sunscreen - this means it protects your skin against both ultraviolet-A (UVA) and UVB rays. It should have a sun protection factor (SPF) of at least 15. It's also a good idea to wear a hat.

Medicines

Immunosuppressants
The most common treatment for alopecia areata is with steroid creams, ointments or lotions. You apply a thin layer directly onto your patches of baldness not more than twice a day. Although you're unlikely to have any side-effects because you will probably only use these for a short time, the response is unpredictable. Alternatively, you may be offered an alternative cream such as tacrolimus.

You may be offered corticosteroid injections into your patches of baldness. These injections may be every few weeks. Hair will usually start growing back within four to six weeks of starting the treatment, and may keep growing for six to nine months after an injection. Side-effects of these injections can include pain when you have the injections, and your skin becoming thinner. This is usually temporary. It's important that you are aware that even if treatment is successful, alopecia areata may still come back. This treatment works best for very small but prominent areas of hair loss.

Contact sensitisation
Alopecia areata is thought to be caused by a problem with your immune response. It's sometimes possible to trick your immune system into changing the things it reacts to. This is done by applying a chemical to your skin which causes an allergic reaction in that area. If applied to areas of hair loss, it may cause your hair to start growing again. This treatment is called contact sensitisation or contact immunotherapy.

Contact sensitisation is not widely available in the UK. The treatment takes several months of hospital visits, and you need to cover the skin that's been treated because sunlight will damage the chemicals used. It works for about half of people with alopecia.

Minoxidil solution/lotion
Minoxidil solution (Regaine) may help your hair to grow more but evidence for its effectiveness is weak, and it takes around 12 weeks to work. You can buy it from a pharmacy. Side-effects can include red and itchy skin.

Dithranol cream or paste
This is not often used because it needs to be applied every night and needs to cause irritation to work. It's awkward to use because it must be washed off after 20 to 60 minutes and it stains hair, clothes and fair skin. It can help in one in three people with alopecia.

Hospital treatment

You may be offered treatment with ultraviolet light. This is called PUVA, and uses UVA light and a medicine called psoralen.

You will have psoralen applied to your skin or take it by mouth. Your skin is then exposed to UVA light which activates the psoralen. You will usually need to have this done twice a week for long periods. If you are given the tablet version, you will need to stay out of the sun and wear photoprotective glasses all day when you have this treatment. PUVA can cause sickness and vomiting, and changes to your skin colour, and it increases the risk of skin cancer.

Talking therapies

It can be upsetting having alopecia, especially for children or young people. If you are having trouble dealing with your hair loss, talk to your GP or dermatologist. He or she may suggest counselling to help you cope.

You may want to join a support group, as it can be helpful to talk to others with the same condition.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.