Causes of Alopecia Areata (Patchy Hair Loss)

Alopecia areata, commonly known as patchy hair loss, is an autoimmune disease that can cause significant and often distressing hair loss. It can lead to feelings of self-consciousness and increased stress as individuals cope with its effects. Understanding the underlying causes of alopecia areata is crucial for selecting the right treatment approach. This article explores the causes, symptoms, diagnosis, and treatment options for this condition.

What is Alopecia Areata?

Alopecia areata is characterized by hair falling out in small patches, often making it difficult to notice initially. This type of hair loss develops when your immune system mistakenly attacks your hair follicles, disrupting the normal hair growth cycle. Sudden hair loss can occur on the scalp, eyelashes, eyebrows, facial hair, and other parts of the body. It typically develops slowly and can recur even after years of treatment.

The amount of hair loss varies from person to person. Some individuals experience hair loss in just a few spots on the scalp, while others experience more extensive hair loss, sometimes leading to complete baldness (alopecia totalis) or even loss of all body hair (alopecia universalis). While there’s no cure for alopecia areata, treatments can help promote hair regrowth and prevent future hair loss.

Causes of Alopecia Areata

Alopecia areata is an autoimmune condition, meaning your immune system mistakenly identifies healthy cells as foreign invaders. Normally, your immune system defends against external threats like bacteria and viruses. In alopecia areata, the immune system attacks the hair follicles, preventing them from functioning properly and causing hair to fall out.

Alopecia areata is more common in people with a family history of other autoimmune diseases, such as type 1 diabetes or rheumatoid arthritis. This suggests a genetic component to the condition’s development. Researchers also believe certain environmental factors may trigger alopecia areata in individuals genetically predisposed to it.

Symptoms of Alopecia Areata

With alopecia areata, hair typically falls out in small, round patches on the scalp, often about the size of a coin or smaller. Hair loss can also occur in other areas, such as the eyelashes, eyebrows, and beard. Some experience hair loss in a few spots, while others develop many large bald patches.

Alopecia areata hair loss may be most noticeable after showering, brushing, or on your pillow. Common symptoms include:

• Small, round bald patches on the scalp or other areas
• Patches that may join to form larger bald spots
• Hair regrowth in one spot while it falls out in another
• Extensive hair loss over a short period
• Red, brittle, and pitted fingernails and toenails

The bald patches are usually smooth and not red or inflamed, though you may experience some itching or burning before the hair falls out. In rare cases, substantial hair loss can signal other types of alopecia, such as alopecia totalis (complete scalp hair loss) and alopecia universalis (complete body hair loss). Alopecia areata is unpredictable, with hair potentially regrowing and then falling out again. The degree of hair loss and regrowth varies among individuals.

Alopecia Areata in Men

Alopecia areata can affect both men and women, but it tends to be more common in men, particularly those with a family history of the condition. In men, hair loss can occur on the scalp, face, chest, and back. Unlike male pattern baldness, alopecia areata typically causes patchy, uneven hair loss.

Alopecia Areata in Women

In women, alopecia areata can occur in patches on the scalp, as well as on the eyebrows and eyelashes. Hair may fall out at the same time or spread, leading to more extensive hair loss. This can be particularly distressing for women, given the social significance of hair.

Alopecia Areata in Children

Children can also develop alopecia areata. In fact, most people with this condition experience their first episode of hair loss before age 30. While genetics play a role in childhood alopecia areata, it doesn’t always occur in children whose parents have the condition. Besides hair loss, children may also experience fingernail and toenail defects, such as pitting or damage. Adults can experience these symptoms as well, but they're more common in children.

Prognosis for Alopecia Areata

The prognosis for alopecia areata varies. It’s a difficult condition to predict, and once you have it, you may experience intermittent episodes of hair loss and related symptoms throughout your life. Some people have just one episode, while others experience recurring hair loss.

Recovery also differs among individuals. Some people experience complete hair regrowth, while others don't, and some experience more hair loss. Factors associated with a less favorable prognosis include:

• Early age of onset
• Extensive hair loss
• Fingernail changes
• Family history
• Other autoimmune conditions

Diagnosing Alopecia Areata

A doctor can usually diagnose alopecia areata by visually examining the hair loss pattern or by examining a few hairs under a microscope. A scalp biopsy might be performed to rule out other conditions that cause hair loss, including ringworm of the scalp. During a biopsy, a small piece of skin from your scalp is removed for laboratory analysis. Blood tests may also be helpful to rule out other autoimmune conditions. These tests can detect the presence of one or more unusual antibodies in your blood.

Treatment for Alopecia Areata

While there’s no cure for alopecia areata, treatments can help improve symptoms:

• Corticosteroids: These anti-inflammatory drugs are often prescribed for autoimmune conditions. They can be injected into the scalp or taken orally, applied as an ointment, cream, or foam. Corticosteroids can take time to produce results.
• Minoxidil (Rogaine): This topical treatment is applied to the scalp. Some see results after 12 months, while others find it less effective.
• Topical immunotherapy: This treatment is used for extensive hair loss or recurring hair loss. Chemicals are applied to the scalp to create an allergic reaction, which can stimulate hair growth. It can cause a rash and itching, and treatments often need to be repeated for hair regrowth.

Home Care for Alopecia Areata

In addition to medical treatments, several self-care practices can help manage alopecia areata symptoms. These include gentle hair brushing, avoiding harsh hair treatments like dyeing, perming, or tight hairstyles, and wearing a wide-brimmed hat to protect the scalp from the sun. Stress management is also important. Research suggests that stress can trigger both alopecia areata and telogen effluvium (another type of hair loss).

The first step to regaining your hair is finding the right approach. Start with our personalized quiz for MEN and personalized quiz for WOMEN