Alopecia Areata: Causes, Symptoms and Treatment Options

What causes alopecia areata?

The exact cause is not fully understood, but alopecia areata happens when the immune system mistakenly attacks hair follicles. Genetics play a role: it is more common in people with relatives who have it, or who have other autoimmune conditions such as thyroid disorders and vitiligo, or allergic conditions such as asthma and eczema.

Some patients notice it after severe stress or illness, but these are possible triggers rather than the sole cause. Alopecia areata is not contagious and is not caused by poor hygiene or poor hair care.

What are the symptoms and forms of alopecia areata?

It usually starts suddenly, and a barber or family member may notice it before the patient does. Signs include:

A dermatologist usually diagnoses alopecia areata by examination and dermatoscopy, may request blood tests for the thyroid or others depending on the case, and rarely needs a biopsy.

• One or more smooth, round or oval bald patches, usually with normal-coloured skin and no scaling.
• Short hairs at the edge of a patch that narrow at the base, like an exclamation mark.
• Patches in the beard in men, or in the eyebrows and eyelashes.
• Small pits or roughness in the nails in some patients.
• Less commonly, loss of all scalp hair or all body hair.

Does the hair grow back on its own?

In mild cases with a few small patches, hair grows back on its own in many patients within months to a year. New hair may be white or light at first, then gradually regain its colour.

However, the course varies from person to person: new patches may appear while old ones recover, and episodes can recur years later. The outlook is usually less favourable when the condition starts in childhood, when hair loss is extensive, or when it involves the back and sides of the hairline.

What treatment options are available?

No treatment prevents alopecia areata permanently, but treatments help hair regrow in many cases. The doctor chooses based on the extent and location of hair loss and the patient's age:

All of these treatments are prescription-only and used under a doctor's follow-up, and some are not suitable during pregnancy and breastfeeding or for children, so do not use any of them without a consultation.

• Steroid injections into the patches: one of the most used treatments for limited patches in adults, repeated about every 4 to 6 weeks.
• Strong steroid creams or lotions: a common choice for children and for people who cannot tolerate injections.
• Topical minoxidil: sometimes used alongside other treatments.
• Topical immunotherapy: for extensive cases, carried out by the doctor in stages.
• JAK inhibitors: newer oral medicines for severe, extensive cases, requiring careful assessment and regular blood tests.

How can you cope with the emotional impact?

Alopecia areata is usually not physically painful, but its emotional impact can be significant, especially for children, teenagers and women, or before an important occasion such as a wedding. Worry and embarrassment are natural, and talking about them with your doctor and family helps a great deal.

You can change your hairstyle or use a head covering or wig for a while, and fill in eyebrows with brow pencils. If the condition clearly affects your sleep, study, work or mood, psychological support is an important part of treatment, not a luxury.