Alopecia areata: patchy hair loss

Not medical advice. This guide is general information from the sources listed, not a diagnosis or a substitute for a pharmacist, GP or dermatologist. If you are worried, or symptoms are severe or not improving, get advice. Read our health information policy.

What it is

Alopecia areata is a common type of hair loss that can happen at any age and affects men and women equally. It usually causes small, round, smooth patches of baldness on the scalp, and it can also affect the beard, eyebrows, eyelashes or body. Rarely it causes loss of all scalp hair (alopecia totalis) or all body hair (alopecia universalis). Some people also notice changes to their nails.

It's thought to be autoimmune: the immune system mistakenly attacks the hair follicles. Importantly, the follicles aren't destroyed, so the hair can grow back. It's linked with other autoimmune conditions such as thyroid disease and vitiligo, and dermatologists say about 2 in 10 people with it have a family history of alopecia areata.

Myths it's worth dropping

• It isn't contagious — it can't spread to other people.
• The British Association of Dermatologists says there's no connection to food or diet.

What happens next

The outlook is unpredictable. Many people find their hair grows back within a year without treatment, especially when patches are small — though the official estimates vary (dermatologists' and NICE figures differ). New hair may come through fine and white at first and regain its colour later. Further episodes are common, and the chance of full regrowth is lower when hair loss is extensive.

Treatments

Mild patches may need no treatment. If you want treatment, options a GP or dermatologist may discuss include:

• Steroid creams, lotions or gels applied to the patches.
• Steroid injections into small patches, given by a specialist.
• Specialist treatments for more extensive loss, such as contact immunotherapy or, for severe cases, newer tablet medicines called JAK inhibitors (one is NHS-funded for severe alopecia areata from age 12).
• Wigs, hairpieces, eyebrow and lash camouflage — some wigs are available on the NHS.

Over-the-counter minoxidil has only limited evidence for alopecia areata on its own. No treatment is a cure, and complementary therapies haven't been shown to make hair regrow.

Looking after yourself

• Protect bald patches from the sun with a hat or sunscreen.
• Avoid styles that pull, and take care not to injure the scalp.
• Alopecia areata can affect confidence and mood; dermatologists note higher rates of anxiety and depression. Talk to your GP about how you feel — counselling and support groups (such as Alopecia UK) can help.