It’s extremely natural to have hairs fall out of your head. In fact, most people shed anywhere from 50 to 100 hairs a day.
But when your hair is falling out in patches, it could mean you have an underlying condition like alopecia areata, an autoimmune disorder that causes hair loss.
Scientists don’t know exactly what causes alopecia areata, but hair loss from the condition is reversible in some cases.
Many treatments are available to manage alopecia, either by helping slow down future hair loss or by helping hair grow back. However, when you have this condition, hair loss tends to come and go. And even with successful treatment, you may have flares every so often.
If you’ve received an alopecia diagnosis, thin or thinning hair doesn’t have to be the only outcome. Here’s everything you need to know about alopecia areata.
Alopecia areata is an autoimmune condition that causes your body’s immune cells to attack your hair follicles, the openings on your skin that hair grows from.
The cause of alopecia is thought to be pretty complex. The condition has a genetic link and has been associated with other autoimmune conditions, including:
- Down syndrome
While it’s common to think of alopecia areata as hair loss that occurs specifically on the scalp, the condition can actually cause hair loss from head to toe. You read that right: anywhere.
Alopecia areata can start at any age, but most people develop it during childhood or their teen years. In the United States, it affects about 6.8 million people of all sexes and ethnicities.
The condition can be categorized into three main types:
- Patchy alopecia areata: patchy baldness that occurs on your scalp, beard area, eyebrows, eyelashes, or armpits or inside your nose or ears, creating one or more patches of hair loss
- Alopecia totalis: total or near-total hair loss on your scalp, resulting in complete baldness
- Alopecia universalis: total hair loss on your body, which leaves your entire body hairless
There are also a few other forms of alopecia areata that are categorized by specific patterns of hair loss.
The American Academy of Dermatology (AAD) estimates that, in about half of people diagnosed with alopecia areata, lost hair grows back without treatment within 1 year.
Sometimes, when the hair grows back, it’s there to stay and will never fall out again. However, some people might experience cycles of hair loss and regrowth.
How does it cause hair loss?
Researchers still don’t fully understand why the immune system attacks the hair follicles, causing alopecia areata. Theories suggest that both genetic and environmental factors play a role.
Many people who develop alopecia have other autoimmune diseases, which could play a role as well.
Other research findings point to a possible genetic link or predisposition, since 20% of people diagnosed with the condition have a family history of hair loss.
Alopecia areata can show up without warning. Here are some symptoms you may experience if the condition is developing:
- oval or round bald patches on your scalp
- hair loss that’s concentrated on one side of your scalp (not both sides)
- patchy hair loss on other typically hairy areas of your body, such as your brows
- areas of hair loss that become smooth and/or become bigger with time
- new patches of hair loss that join existing patches
- small dents in your nails (pitting)
- rough texture on your nails
- fragile nails or nail breakage
- red spots in the lunula (the whitish, crescent-shaped part at the base of your nail)
- white spots on your nails
Keep in mind that new patches don’t always mean you’re losing more hair. Older patches of lost hair can grow back, even as new ones form elsewhere.
While hair loss isn’t physically painful and alopecia areata isn’t life threatening, the condition can still have a major impact on your mental well-being. One small 2014 study of 50 people with the condition found that 38% had depression and 62% had anxiety. It’s important to make your mental health a priority if you have alopecia.
A dermatologist — a doctor who specializes in skin care — will usually need to diagnose alopecia areata. They will examine any areas of hair loss, look at your nails, and ask you questions about your symptoms.
They might also use a tool called a dermascope to get a closer look at your skin. This alone may be enough for a diagnosis, but your dermatologist might also suggest blood work to rule out other possible causes for your hair loss.
While no test can specifically pinpoint alopecia areata, a combination of tests will help you and your doc get to the bottom of your hair loss.
There are numerous ways to treat and manage alopecia areata, but no one treatment works for everybody. The severity of your condition, the locations of your hair loss, and your age and overall health will determine your treatment options.
Just a bit of hair loss
When alopecia areata causes only a few patches of hair loss, a doctor may recommend the following treatments to help regrow hair:
- Prescription-strength corticosteroid creams: Applied one or two times daily, these creams can help regrow hair in bald spots.
- Cortisone injections: The AAD considers steroid injections the most effective treatment when people experience minor, patchy hair loss.
- Minoxidil (Rogaine): You can apply this a few times each day to help maintain any hair growth sparked by another treatment, such as steroids.
- Anthralin: This medication actually causes some irritation on your skin. After applying it, you let it sit on the affected areas and then wash it off.
A lot of hair loss
When alopecia areata causes a lot of hair loss or when the hair is falling out very fast, a doctor may recommend one or a combination of the following treatments:
- Oral corticosteroids: These can have serious side effects, so you won’t be able to take them for long periods. But they’ve been shown to help with hair regrowth after a few weeks of use.
- Contact immunotherapy: Expect weekly appointments over a few months, during which a healthcare professional will apply a chemical to any bald patches, causing a rash. The goal is to reset your immune system so it doesn’t attack your hair follicles.
- Methotrexate: This medication has been shown to help regrow hair after a few months of use. Doctors prescribe it to suppress the immune system, as a treatment for many autoimmune diseases. But it also has some pretty serious side effects, so its use is limited.
- Cyclosporine: This is another immunosuppressant drug used to treat severe alopecia areata.
- JAK inhibitors: When other treatments have failed, these prescription medications can treat excessive hair loss. The three that have undergone research for alopecia areata are ruxolitinib (Opzelura), tofacitinib (Xeljanz), and baricitinib (Olumiant), which is FDA-approved to treat the condition.
There are also newer systemic meds in clinical trials right now that have shown promising results — so more treatment options may be on the way!
Be sure to have a conversation with your doc to fully understand the benefits and drawbacks of these alopecia areata treatment options.
In addition to traditional treatment options, there are steps you can take on your own to address hair loss or reduce any discomfort that hair loss may cause.
Try these tips at home or when you’re out and about:
- Keep any affected areas covered, since alopecia can make you sensitive to cold and sun damage.
- Wear hats and/or scarves to stay warm, especially if you have hair loss on your scalp.
- If you’ve lost nose hairs, apply antibiotic ointment inside your nose to keep out dust and germs.
Although this may be easier said than done, managing stress can also reduce the severity of alopecia areata cycles. Since stress is a key trigger for autoimmune diseases, keeping your stress levels as low as possible may prevent or reduce cycles of hair loss.
Many people who have alopecia say that stress can make it worse. Consider trying some relaxation techniques, such as yoga and meditation, until you find one that feels right for you.
Additionally, certain cosmetics and accessories can help people with alopecia areata feel more feel comfortable in their skin. Depending on your preferences, you may want to try using any of the following to help cover balding areas or re-create the appearance of hair on bald or balding areas:
- false eyelashes
- stick-on eyebrows
- temporary or permanent tattoos
Alopecia areata is an autoimmune condition that causes patchy hair loss. It doesn’t have a cure, and researchers aren’t certain of the exact cause, but treatment options are available that can help you regain lost hair or prevent further hair loss. In many cases, hair will grow back on its own, with or without treatment.
If you’ve received a diagnosis of alopecia areata, it’s important to prioritize your mental health and well-being as you navigate hair loss and treatment. This might take some trial and error.
Keep your doctor informed of any changes in your physical, mental, or emotional health throughout your journey.