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Skin And Rashes

Alopecia areata

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Definition

Alopecia areata is a condition that causes round patches of hair loss, and can lead to total hair loss.

Alternative Names

Alopecia totalis; Alopecia universalis

Causes, incidence, and risk factors

The cause of alopecia areata is unknown. About a fifth of people with this condition have a family history of alopecia.

Alopecia areata is thought to be an autoimmune condition. This occurs when the immune system mistakenly attacks and destroys healthy body tissue.

Alopecia areata is seen in men, women, and children. A major life event such as an illness, pregnancy, or trauma occurs before the hair loss in some, but not most patients

Forms of alopecia include:

  • Alopecia areata -- patches of hair loss, usually on the scalp, but they also can be in the beard or other areas
  • Alopecia totalis -- complete loss of scalp hair
  • Alopecia universalis -- total loss of all body hair

See also:

  • Female pattern baldness
  • Hair loss
  • Male pattern baldness

Symptoms

Most of the time there are no other symptoms besides hair loss, but some people may feel a burning sensation or itching.

Alopecia areata usually begins as one to two patches of hair loss, most often on the scalp. It may also be seen in the beard, eyebrows, and arms or legs.

Roundish patches of hair loss are smooth, and may be peach-colored. Hairs that look like exclamation points are sometimes seen at the edges of a bald patch.

  • Loss of all scalp hair (alopecia totalis), often within 6 months after symptoms first start.
  • Loss of all scalp and body hair (alopecia universalis).

Signs and tests

On occasion, a scalp biopsy may be performed. Several blood tests may be done, because alopecia areata may occur with autoimmune conditions.

Treatment

If hair loss is not widespread, the hair will likely regrow in a few months, whether or not treatment is used.

Even for more severe hair loss, it is not clear whether treatments will change the course of the condition.

Typical therapy may include:

  • Steroid injection under the skin surface
  • Topical corticosteroids
  • Topical immunotherapy
  • Topical minoxidil
  • Ultraviolet light therapy
  • Use of wigs

Irritating drugs may be applied to hairless areas to cause the hair to regrow.

Expectations (prognosis)

Full recovery of hair is common.

However, some people may have a poorer outcome, including those with:

  • Alopecia areata at a young age
  • Eczema (atopic dermatitis)
  • Long-term alopecia
  • More widespread or complete loss of scalp or body hair

Complications

Permanent hair loss is a possible complication of alopecia areata.

Calling your health care provider

Call for an appointment with your health care provider if you are concerned about hair loss.

References

Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2009: pp 932-934.

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