What Is Alopecia Areata? Symptoms, Causes and Treatment
Alopecia areata is an autoimmune condition in which the immune system mistakenly attacks healthy hair follicles, causing hair to fall out in smooth, round patches, most often on the scalp. It affects women and men of all ages, it is not contagious, and in around half of cases hair regrows within a year without treatment. For the rest, effective medical treatments exist, so the most important step is seeing a GP or dermatologist for a proper diagnosis. Here is a clear guide to the symptoms, causes and options.
Key takeaways
- Alopecia areata is an autoimmune condition causing smooth, coin-sized bald patches.
- It is one of the most common causes of patchy hair loss and is not contagious.
- Around half of cases regrow within a year; medical treatments help others.
- It is linked to other autoimmune conditions and can be triggered by stress or illness.
- See a GP or dermatologist early, diagnosis is quick and treatment options are real.
What is alopecia areata?
It is a form of alopecia (the medical term for hair loss) with a very distinctive signature: hair falls out in round or oval patches, leaving smooth skin with no scarring, redness or scaling. It differs from androgenetic alopecia (gradual pattern thinning) and traction alopecia (loss from tension on the hair). Sometimes called "spot baldness", it usually affects the scalp, though patches can appear in the beard, brows or elsewhere.
Rarer, more extensive forms exist: alopecia totalis (loss of all scalp hair) and alopecia universalis (loss of all body hair), but the patchy form is by far the most common, and progression to the extensive forms is rare.
What causes alopecia areata?
It is autoimmune: the body's immune system mistakenly treats hair follicles as a threat and attacks them, pushing hairs out and pausing growth. Why this starts is not fully understood, but known threads include:
- Genetics: it can run in families.
- Other autoimmune conditions: it is more common in people with thyroid disease, vitiligo, coeliac disease, type 1 diabetes, lupus or eczema.
- Triggers: significant stress, illness, shock or grief appear to trigger episodes in some people.
Importantly: the follicles are damaged but usually not destroyed, which is why regrowth is so often possible.
What are the symptoms?
- Round, smooth bald patches, typically coin-sized, sometimes larger, appearing quite quickly.
- "Exclamation mark" hairs at the patch edges, short hairs thicker at the tip and narrower at the root. They are subtle; a GP, dermatologist or trichologist identifies them with a dermatoscope, and they signal active disease.
- Tingling, itching or burning where a patch is about to appear, an early warning some people notice.
- Nail changes: fine pitting (like pinpricks) or brittleness in the fingernails accompanies it in some cases.
How is alopecia areata treated?
There are two encouraging facts. First, in roughly half of cases with limited patches, hair regrows by itself within about a year. Second, for cases that persist or spread, real medical treatments exist, prescribed and monitored by a doctor:
| Treatment | What it is |
|---|---|
| Topical corticosteroids | Steroid creams or lotions applied to patches |
| Corticosteroid injections | Small injections into patches, common for limited disease |
| Contact immunotherapy | Specialist treatment that retrains the immune response |
| Newer prescription medicines | JAK-inhibitor tablets are now licensed for severe alopecia areata in some cases, ask a dermatologist |
| Support and stress care | Counselling and stress management support wellbeing and may help with triggers |
The right option depends on your age, the extent of the patches and how long they have been there, which is exactly why a GP or dermatologist should guide it.
Living with alopecia areata
Patchy hair loss can be emotionally heavy, and that deserves acknowledging. A few things genuinely help: getting a firm diagnosis (uncertainty is often the worst part), connecting with support communities such as Alopecia UK, and doing whatever makes you feel most yourself, whether that is concealing patches with styling, scarves or fibres, or embracing the change entirely. Gentle hair care avoids stressing the surrounding hair, but no shampoo or cosmetic product treats the condition itself, be wary of anything that claims to.
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Frequently asked questions
Is alopecia areata permanent?
Often not. Follicles are usually not destroyed, and around half of limited cases regrow within a year. The course varies, and episodes can recur.
Is alopecia areata contagious?
No. It is an autoimmune condition and cannot be passed on.
What triggers alopecia areata?
Genetics set the susceptibility; stress, illness, shock and grief appear to act as triggers in some people. It is also more common alongside other autoimmune conditions.
How is it diagnosed?
A GP or dermatologist usually diagnoses it by examining the scalp and hairs, sometimes with a dermatoscope, quick and painless.
Can stress cause bald patches?
Stress appears to be a trigger for alopecia areata in susceptible people, and stress management is a sensible part of any plan.
Does alopecia areata affect children?
Yes, it can start at any age, including childhood. See our guide to hair loss in children.
Can any shampoo treat alopecia areata?
No. It is a medical condition needing medical treatment. Gentle hair care supports the hair around patches but does not treat the condition.
Alopecia areata is unpredictable, but it is common, well-understood and very often reversible, and you do not have to navigate it alone. See your GP or a dermatologist for diagnosis and options, and lean on the support out there. For related reading, see stress and hair loss and thyroid-related hair loss.
