Alopecia areata is an autoimmune condition in which the immune system turns on the hair follicle, causing smooth, round, coin sized bald patches that appear over a few weeks. It is not contagious, it is not caused by anything you did, and the follicle is not destroyed. For about four in five people affected, complete recovery of the hair happens within a year without any medical intervention at all.

What is alopecia areata?

Alopecia areata is a form of non scarring hair loss driven by the immune system. In simple terms, immune cells gather around the base of the hair follicle and interrupt the growth phase. The hair in that follicle falls, and new hair is held back while the immune activity continues.

The word non scarring matters more than it sounds. In scarring conditions the follicle is replaced by fibrous tissue and the hair is gone for good. In alopecia areata the follicle stays alive and intact underneath the skin, dormant rather than destroyed. That is the single most important fact about the condition and it is the reason hair can still return months or even years later.

It affects roughly 1 in 50 people at some point in their lives, across every age, sex and ethnicity. It commonly appears for the first time in childhood or early adulthood, though it can start at any age.

What does alopecia areata look like?

The classic presentation is distinctive enough that most people recognise it once it is described. A patch appears suddenly, often noticed by a hairdresser or a family member before the person themselves.

• Smooth, round or oval patches, usually between the size of a five pence piece and a two pound coin.
• Normal looking skin inside the patch. No redness, no scaling, no soreness and no scarring.
• Exclamation mark hairs at the edge of an active patch: short broken hairs that taper towards the scalp, thinner at the bottom than the top.
• Nail changes in some people, most often fine pitting that looks as though the nail has been tapped with a pin.
• Other sites affected in some cases, including the beard, eyebrows, eyelashes, arms and legs.

Two less common patterns have their own names. When all the scalp hair is affected it is called alopecia totalis, and when hair is lost across the whole body it is called alopecia universalis. Both are far less common than the patchy form.

Hair loss, hair shedding and hair breakage are three different things

People use these words interchangeably and it causes real confusion, because the three have different causes and completely different outlooks. Getting the distinction right is often the fastest route to understanding what is happening on your own head.

Alopecia areata sits firmly in the first row. If instead you are seeing diffuse thinning all over with no clear patches, that points somewhere else entirely, and our guide to what causes telogen effluvium is the better starting point. If you want the three mechanisms side by side in more detail, we set them out in what causes thinning hair.

What causes alopecia areata?

The honest answer is that the trigger is not fully understood, and anyone who tells you otherwise is guessing. What is well established is the mechanism: the immune system stops recognising the hair follicle as part of the body and mounts a response against it.

Genetics play a part. Around one in five people affected has a family member who has also had it, and specific immune related gene variants are associated with a higher likelihood.

Other autoimmune conditions cluster with it. Thyroid disease, vitiligo, type 1 diabetes and coeliac disease all appear more often in people with alopecia areata than in the general population. This is why a GP may suggest a blood test to check thyroid function and iron levels.

Stress is commonly blamed and rarely proven. Many people can point to a stressful period before a patch appeared, but the evidence for stress as a direct cause is weak and the association may run the other way, since losing hair is itself extremely stressful. It is worth reading our piece on whether stress really causes hair loss, because the honest answer differs by mechanism.

It is not caused by diet, shampoo, hats or hair products. No cosmetic product causes alopecia areata and no cosmetic product can resolve it. Anyone selling you one on that basis is not being straight with you.

What usually happens next?

For most people the outlook is genuinely encouraging, and this is the part that rarely gets said clearly enough at the start.

Around four in five people with a single small patch see their hair return completely within twelve months, with no medical intervention at all. New hair often comes through fine, soft and white or grey at first, and usually takes on its normal colour and texture over the following months. That white new growth phase alarms a lot of people unnecessarily.

The condition does tend to come and go. A patch that resolves may be followed by another one months or years later, and that pattern is normal rather than a sign that something has gone wrong. A less favourable outlook is associated with starting in early childhood, having very extensive involvement, losing hair at the hairline around the edge of the scalp, and having nail changes.

There is no cure for alopecia areata, and that is worth saying plainly rather than dancing around. What exists are options that may help while the immune activity settles, and a strong likelihood that it settles on its own.

When should you see your GP?

Speak to your own GP if any of the following apply. This is a medical condition and it deserves a proper medical opinion rather than an internet search.

• A bald patch has appeared and you are not sure why.
• Patches are spreading, joining up, or new ones keep appearing.
• The skin in the patch is red, scaly, sore, itchy or scarred, which points to something other than alopecia areata.
• Eyebrows, eyelashes or beard hair are affected.
• A child is affected, since children need a proper assessment and other causes are more common at that age. Our guide to hair loss in children covers what to expect.
• You are struggling with how this is making you feel. That is a legitimate reason to see a GP on its own, and a common one.

Your GP can confirm what is happening, usually just by looking, and may arrange blood tests to check thyroid function, iron and vitamin D. Where the picture is unclear or extensive, they can refer you to a dermatologist.

What might a dermatologist discuss with you?

A specialist has several prescription options available, and which of them is appropriate depends entirely on your age, how much hair is affected, how long it has been going on and your general health. That conversation belongs with them, not with a shampoo company, so this article deliberately does not name medicines.

What is worth knowing beforehand is the shape of the landscape. Some approaches aim to calm the local immune response in a patch. Others work across the whole immune system and are reserved for extensive cases because they carry more significant risks and need monitoring. The British Association of Dermatologists publishes a living guideline that is updated as new evidence lands, which is a useful sign of how quickly this area is moving.

Two practical points. First, NHS availability varies by region and not everything discussed online is routinely funded here. Second, NHS wig provision exists, and Alopecia UK and the British Association of Dermatologists have jointly published a charter recommending a minimum of two acrylic wigs a year for people who need one. Ask about it, because it is not always offered.

How should you look after your hair and scalp day to day?

Nothing you put on your scalp changes the immune activity behind alopecia areata. What sensible care can do is protect the hair you still have, keep the scalp comfortable, and stop breakage adding a second problem on top of the first.

• Be gentle when the hair is wet. Wet hair stretches and snaps far more easily. Detangle from the ends upwards with a wide tooth comb.
• Ease off tight styles. Tight ponytails, buns and braids pull at the hairline and can cause a separate, avoidable kind of loss over time.
• Turn the heat down. Lower dryer and straightener settings, and always a heat protectant if you are using either.
• Protect the bare skin from sun. A patch on the scalp has no hair shielding it, so a hat or a high factor sunscreen matters on bright days.
• Keep the scalp comfortable. A light oil or a mild conditioner is plenty. Harsh scrubs and strong actives are not needed and can make things feel worse.

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A simple, vegan conditioning oil for dry lengths and a scalp that feels tight. Cosmetic care for the hair you have, nothing more than that. Made in the UK.

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Watermans products are 100% cosmetic and do not treat medical hair loss. Individual results may vary.

Where can you find support?

The psychological weight of alopecia areata is consistently underestimated, including by clinicians. Losing hair suddenly, in visible patches, with no clear cause and no reliable timeline, is genuinely difficult, and finding it difficult is not vanity.

Alopecia UK is the main charity here and runs support groups, an online community and practical information about wigs, hair pieces and cosmetic camouflage. Many people find talking to someone who has been through it more useful than any leaflet. If your mood is being affected, tell your GP, because that is part of the condition and not a separate embarrassment.

Frequently asked questions about alopecia areata

Is alopecia areata permanent?

Usually not. The follicle survives, and about four in five people with a single patch see their hair return fully within a year. The condition can recur, but a bare patch is not a permanent one in most cases.

Is alopecia areata contagious?

No. It is an autoimmune condition and cannot pass from person to person by any route.

Does alopecia areata itch or hurt?

Usually neither. Some people notice a slight tingling or burning in a patch just before hair falls, but the skin itself looks and feels normal. Pain, scaling or soreness suggests a different condition and is worth showing your GP.

Why is the new hair white?

New growth often comes through unpigmented because the pigment producing cells take longer to restart than the hair producing ones. Colour typically returns over the following months.

Can diet or supplements help alopecia areata?

No supplement has been shown to change the course of the condition. Correcting a genuine deficiency in iron or vitamin D is worthwhile for your general health, which is why a GP may test for it, but that is a different claim from fixing the condition.

Will shaving my head help?

It makes no difference to the underlying condition. Plenty of people choose to shave because it feels better than watching patches spread, and that is an entirely valid personal decision.

Can children get alopecia areata?

Yes, and childhood is one of the more common times for it to start. Children should always be seen by a GP, because other causes such as fungal infection are more common at that age and need a different approach.

Does stress cause it?

Stress is frequently blamed and the evidence is weak. Losing hair causes a great deal of stress in its own right, which makes the direction of the relationship hard to untangle.

The bottom line

Alopecia areata is an autoimmune condition that switches hair follicles off rather than destroying them, which is why the hair returning is the usual outcome rather than the exception. See your GP so someone can confirm what is happening and rule out the conditions that look similar, ask about specialist referral if patches are spreading, and ask about wig provision if you need it. In the meantime, look after the hair you still have kindly and get support if the emotional side is weighing on you, because that part is real and it is common.

Watermans products are 100% cosmetic and do not treat medical hair loss. Individual results may vary. Nothing on this page is a substitute for advice from your own GP or dermatologist.

Sources and References

• Alopecia areata, British Association of Dermatologists public information leaflet.
• New British Association of Dermatologists living guideline for managing people with alopecia areata.
• Hair loss, NHS.
• Alopecia UK, support, community and practical information.