What is it?
‘Alopecia’ is a general term use to describe hair loss. Alopecia areata
(pronounced al-oh-PEE-shah air-ee-AH-tah) is a condition in which patches of hairs fall off without permanent destruction of the hair follicles. It usually affects the scalp, but may also occur on the eyebrows, eyelashes and beards. The hair may regrow to be followed by new patches of hair loss.
What causes it?
Alopecia areata is thought to be an autoimmune disease. This simply means that the cells in your body that normally fight infection (white blood cells) attack some of your own cells by mistake. In alopecia areata, they gather around hair follicles, which are the sacs from which individual hairs grow. This causes inflammation around the follicles, making your hair stop growing, fall out, and not regrow. Fortunately, your hair follicles aren’t permanently damaged, so your hair still has the potential to grow back.
Your doctor will usually search for other autoimmune diseases which may be associated with this condition such as atopy and Down’s syndrome.
Who may be affected?
Alopecia areata affects people of all backgrounds and ages. Many get it first as a child or young adult.
It is still unclear why some people get alopecia areata and others don’t. However, it has been found to run in families. You may also be more likely to get it if you or someone in your family has another type of autoimmune disease, such as type 1 diabetes, thyroid disease, or vitiligo (a condition that causes white patches on the skin).
How bad can it get?
Most people have one or a few patches of hair loss on their scalp, but some lose a significant amount of their hair. Less commonly, people lose all the hair on their scalp (called alopecia totalis) or all the hair on their scalp and body (alopecia universalis).
The outlook is usually less good with larger patches and when the alopecia appears early in life or is associated with allergy.
What are the symptoms?
Most people get patches of hair loss over a few weeks. The patches are usually coin-sized and round or oval. The scalp without hair is smooth and looks normal (it’s not red or inflamed). Some people may feel tingling or very minor pain in the affected area.
You may have short hairs (around 3 millimetres long) at the edges of these patches, and these are described as ‘exclamation mark’ hairs. The nails may also appear rough or slightly dented.
What treatments work?
Successful treatment of alopecia is difficult, and patients require support and reassurance. Treatments may help the hair to grow back but do not have any effect on long-term progression, and many people with alopecia areata have regrowth without any treatment, particularly if their hair loss is mild. As a result, some people choose not to have any treatment. Widespread hair loss is more difficult to treat.
If you have mild to moderate hair loss, your doctor may use corticosteroid injections or apply medicines on your skin. Having steroids injected directly into the site of the hair loss is the best treatment for areas of patchy alopecia, with regrowth usually starting in one to six months. However, they don’t work for everyone, and they aren’t usually used for children. You may need to have injections more than once and these are usually spaced four to six weeks apart. Injections can sometimes cause thinning of the skin, acne (spots) and redness at the site of the injections but these are usually temporary.
Steroids also come as gels, liquids, creams, and lotions that you put directly on areas of hair loss. These topical steroids are less likely to cause side effects than steroid injections, and may be used in children. Occasionally doctors prescribe steroid tablets if someone is having rapid hair loss. This can help stop or slow their hair loss. However, the improvements may only be temporary, as steroid tablets can only be used for a short amount of time. This is because they can cause many side effects.
Minoxidil may sometimes be used for alopecia but often does not help, and you may get some skin irritation when using it.
If a treatment hasn’t worked after six months, an alternative may be sought for here
Coping with hair loss
It can be a very difficult thing for people to deal with their hair loss. It is especially devastating for children and teenagers, who may already be struggling with their self-esteem. Your doctor can provide support, and may recommend talking to a counsellor or attending a support group. Meeting other people with alopecia areata can be a huge help. You may choose to wear a wig, hat or scarf, or apply coloured scalp powders, sprays or pastes to disguise the hair loss. Some people shave their head until their hair starts to regrow. Make-up and temporary tattoos are options for hiding lost eyebrows.
What will happen to me?
No matter how severe your hair loss is, you still have the potential to regrow hair, since your hair follicle is not permanently damaged. However, the chance of full regrowth is higher in mild cases. Your hair may be lighter or fine when it first grows in, but it should return to its normal colour and texture.
Some people may regrow hair after many years. However, the longer you have no regrowth, the less likely it is that your hair will grow back. But remember: alopecia areata is an unpredictable condition, and no one can say for sure how it will affect you.