What is alopecia areata?

Alopecia areata is a hair-loss condition which usually affects the scalp. It can, however, sometimes affect other areas of the body. Hair loss tends to be rather rapid and often involves one side of the head more than the other.

Alopecia areata affects both males and females. This type of hair loss is different than male-pattern baldness, an inherited condition.

What causes alopecia areata?

Current evidence suggests that alopecia areata is caused by an abnormality in the immune system. This particular abnormality leads to autoimmunity. As a result, the immune system attacks particular tissues of the body. In alopecia areata, for unknown reasons, the body's own immune system attacks the hair follicles and disrupts normal hair formation. Biopsies of affected skin show immune cells inside of the hair follicles where they are not normally present. What causes this is unknown. Alopecia areata is sometimes associated with other autoimmune conditions such as allergic disorders, thyroid disease, vitiligo, lupus, rheumatoid arthritis, and ulcerative colitis. Sometimes, alopecia areata occurs within family members, suggesting a role of genes and heredity.

What are the different patterns of alopecia areata?

The most common pattern is one or more spots of hair loss on the scalp. There is also a form of more generalized thinning of hair referred to as diffuse alopecia areata throughout the scalp. Occasionally, all of the scalp hair is lost, a condition referred to as alopecia totalis. Less frequently, the loss of all of the hairs on the entire body, called alopecia universalis, occurs. Sometimes the hair loss can involve the male beard, a condition known as alopecia areata barbe.

Who is affected by alopecia areata?

Alopecia areata tends to occur most often in children, teens, and young adults. However, it can also affect older individuals and rarely toddlers. Alopecia areata in not contagious. It should not be confused with the hair shedding that may occur following the discontinuation of hormonal estrogen and progesterone therapies for birth control or the hair shedding associated with the end of pregnancy.

How is alopecia areata diagnosed?

The characteristic finding of alopecia areata is the exclamation point hair. These unusual hairs can be found in areas of hair loss. They are visible with a hand lens as short, broken off hairs that are narrower closer to the scalp (appearing like an exclamation point). A biopsy of the scalp is sometimes necessary for a diagnosis.

How is alopecia areata treated?

In approximately 50% of patients, hair will regrow within a year without any treatment. The longer the period of time of hair loss, the less likelihood that the hair will regrow. A variety of treatments can be tried. Steroid injections, creams, and shampoos (such as clobetasol or fluocinonide) for the scalp have been used for many years. Other medications include minoxidil, irritants (anthralin or topical coal tar), and topical immunotherapy (cyclosporine), each of which are sometimes used in different combinations.

A study reported in the journal Archives of Dermatology (vol. 134, 1998;1349-52) showed effectiveness of aromatherapy essential oils (cedarwood, lavender, thyme, and rosemary oils) in some patients. As with many chronic disorders for which there is no single treatment, a variety of remedies are promoted which in fact have no benefit. There is no known effective method of prevention, although the elimination of emotional stress is felt to be helpful. No drugs or hair-care products have been associated with the onset of alopecia areata. Much research remains to be completed on this complex condition.

Alopecia Areata At A Glance

• Alopecia areata is a hair-loss condition which usually affects the scalp.
• Alopecia areata typically causes one or more patches of hair loss.
• Alopecia areata tends to affect younger individuals, both male and female.
• An autoimmune disorder, in which the immune system attacks hair follicles, is believed to cause alopecia areata.
• For most patients, the condition resolves without treatment within a year, but hair loss is sometimes permanent.
• A number of treatments are known to aid in hair regrowth. Multiple treatments may be necessary, and none consistently works for all patients.
• Many treatments are promoted which have not proven to be of benefit.

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