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Alopecia Areata: Causes, Symptoms, and Treatments

Katelyn Hagerty FNP

Medically reviewed by Katelyn Hagerty, FNP

Written by Our Editorial Team

Last updated 3/31/2021

Hair loss can come in many forms — a reclining hairline, reduced hair mass, thinning temples, etc. But if you notice that your hair has started to fall out in patches, you are most likely dealing with alopecia areata.

Alopecia areata is a fairly common form of hair loss, affecting around two percent of the population at some point in life. It is second only to androgenetic hair loss, whose reach covers 50 percent of men, and women aren't left out of the equation either.

A few missing patches of hair can be upsetting, but this form of alopecia areata is relatively harmless and may be managed effectively with the right methods. However, different forms of this condition exist. Its most advanced variation is the complete loss of hair, not only on the scalp but also the whole body — this may not be as easily controlled.

We'll be learning about the causes of alopecia areata, its types, and possible treatment methods.

Causes of Alopecia Areata

Alopecia areata is an autoimmune condition. This is where your body's immune system wrongly identifies harmless cells as dangerous outsiders and attacks them. In this case, the hair follicles are targeted, compromising their immunity.

The exact cause of this form of hair loss is still up for debate. Some believe it may result from an infection, much like tinea captis — a fungal infection that also leads to a patchy loss of hair. Its appearance following exposure to thallium, a toxic, odorless metal also led to associations with accidental poisonings.

However, the most widely accepted explanation paints alopecia areata as a disorder of the hair follicle cycle.

When the inflammatory cells wrongly attack, they go against hair follicles that are in the anagen stage of the growth cycle. This is the first stage of the cycle, when the hair follicle begins to grow.

This attack pushes the hair follicles prematurely into the second phase of growth, otherwise known as the catagen phase. Ideally, this is where the hair follicle transitions out of its growth phase.

Following this, the affected hair follicles are pushed to the telogen or resting stage, which is usually when the hair follicle rests and the club hair is completely formed.

The changes made to the hair follicle lead to a weakness in the hair shaft. This causes the hair to break easily when it emerges onto the skin surface, leading to hair loss.

However, while hair follicles are attacked, the hair follicle stem cells from which new hair grows are left unaffected.

This usually spells good news for hair growth, as the follicles are able to go through the growth cycle and produce new hairs.

Beyond an immune reaction however, other factors may contribute to the emergence of alopecia areata. 

High levels of free radicals — atoms that can damage the body's cells and cause illness, have been discovered in people living with this condition. This suggests that free radicals may have a role to play in the formation of alopecia areata.

Likewise, environmental triggers such as emotional or physical stress after a painful loss may trigger cell death in hair follicles. Vaccinations like the hepatitis B shot and medication used to treat psoriasis have also been linked to alopecia areata.

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Types of Alopecia Areata

While alopecia areata is easily recognized by missing patches of hair on the scalp, different forms of this condition exist, with some variants going beyond the hair to affect other parts of the body 

They include:

  • Alopecia totalis: Alopecia totalis is the total, or just about total loss of hair on the scalp.

  • Alopecia universalis: This extends from hair loss on the scalp to other parts of the body with hair i.e the legs, arms etc.

  • Ophiasis: This form of alopecia areata deviates from the patchy shape, to cause hair loss in a wave-like form. It usually attacks the margins of the hair.

  • Sisaipho: Unlike ophiasis which causes the loss of hair along the sides and back of the scalp, this condition retains those hairs, but causes a significant loss of hair along the middle and top of the hair.

  • Marie-Antoinette syndrome: also known as canities subita, this condition causes a distinct and seemingly overnight whitening of the hair. In some cases, hair whitening occurs with the loss of hair that still contains pigment.

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Symptoms of Alopecia Areata

Alopecia areata is a non-scarring form of hair loss, meaning it doesn't lead to blemishes on the parts of the body affected. However it does come with some noticeable symptoms, some of which include:

  • A small round or oval bald patch on the scalp

  • Strips of missing hair as seen in ophiasis and sisaipho

  • More advanced forms of alopecia areata may lead to one or more bald patches in the beard area

  • Widespread hair loss on the head

  • Loss of eyelashes, arms and leg hairs and hairs on othe parts of the body

  • In some instances, alopecia areata may cause the appearance of red nails

  • Other times, this condition may lead to brittle nails

  • In most cases, grey and white hairs often remain where hair loss has occurred

Treatments of Alopecia Areata

To help manage alopecia areata, the following treatment methods may be adopted:

  • Corticosteroids: These are usually the first resort to help with managing this condition. Corticosteroids are an effective option thanks to their ability to suppress immune attacks on the hair follicles.

    They include topical and intralesional corticosteroids.

  • Topical corticosteroids: These are available in lotion, foam, or shampoo formulations. They are typically used where only small patches of alopecia areata are present, and can help to quicken hair growth in mild cases. However, they may not be as effective in more serious cases such as alopecia totalis.

  • Intralesional steroids: These are  administered via injections and are perhaps the most effective treatment for patchy alopecia. They help to stimulate hair growth in the injected areas, but may not be effective against alopecia in areas where it is not administered. 

    Like topical formulations, this treatment may not be effective against more advanced forms of alopecia areata.

  • Topical immunotherapy: Where alopecia has affected almost half of the scalp, topical immunotherapy is usually the recommended option to manage it. 

    This method introduces contact dermatitis to the scalp to trigger an immune response by the body. When this happens, it can stimulate hair growth.

  • Minoxidil: This medication acts as a vasodilator i.e, it improves the flow of blood to the areas affected, increasing the supply of oxygen and nutrients to the hair. This can stimulate hair growth and increase the density of the re-grown hair.

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Wrapping Up

Alopecia areata is a faily common form of hair loss which can be singled out for its patchy pattern.

Other forms of this condition exist, with extreme forms leading to the loss of hair on parts of the body with hair.

Different methods are available to help with managing this condition, with corticosteroids being the most widely accepted. Others include immunotherapy and minoxidil.

For the best results, check in with a trichologist to determine the option most suited for your needs.

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Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

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This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.