About seven million people in the United States have alopecia areata, an autoimmune condition that causes hair loss. It’s the second most common type of hair loss, following androgenetic alopecia, or male and female pattern baldness.

This overview of alopecia areata covers key information, including what it is, how it’s diagnosed, and how it’s treated.

What Is Alopecia Areata?

Alopecia areata is an autoimmune condition. In autoimmune conditions, the immune system mistakenly attacks healthy parts of the body. In alopecia areata, the attack targets the hair follicles, causing coin-sized patches of hair loss on the scalp or other areas of the skin.

Types of Alopecia Areata

People may develop different types of alopecia areata based on the amount of hair loss and where it’s located. These include:

• Diffuse alopecia areata — Hair thins evenly, not in patches.
• Ophiasis alopecia areata — Hair loss occurs around the base of the skull.
• Alopecia barbae — Hair loss affects the beard.
• Alopecia totalis — Hair loss affects the whole scalp.
• Alopecia universalis — Hair loss occurs on the whole body.

What Causes Alopecia Areata?

Scientists aren’t sure what causes the immune system to attack healthy hair follicles in so many people. They know that genetics plays a major role in its development, but they aren’t sure if it’s triggered by an illness, an environmental factor, a mixture of the two, or something else.

Risk Factors

About 20 percent of people who develop alopecia areata also have at least one family member with the condition. The risk of developing it increases if a relative lost their hair before age 30. The risk is also greater during childhood.

Signs and Symptoms of Alopecia Areata

The main symptoms of alopecia areata include:

• Patchy, unpredictable hair loss
• Cupuliform depressions (also known as nail pitting or dents in the nails)

Alopecia areata can affect many body areas. Up to 95 percent of the time, hair loss occurs on the scalp. It can also affect the beard, eyebrows, and other parts of the body (like the arms or legs). When it affects the scalp, it may affect more of one side instead of both.

While hair loss is the most obvious and common symptom, people may experience others, including:

• Burning and pruritus (itching) in hairless patches before or after hair loss
• More hair loss in cold months
• Exclamation point hairs (hairs that are thinner by the scalp and thicker toward the end)
• Hair breakage during regrowth
• White or gray hairs that grow in affected patches
• Wider follicular ostia (visibly open follicles)
• Cadaver hairs, or hair shafts in the follicle that appear as black dots

Hair can grow back, especially when people only have a few areas of hair loss, but it’s unpredictable. Regrowth is sometimes finer or lighter than before, although appearance can be improved with treatment. The regrowth can fall out again, but not always.

How Alopecia Areata Is Diagnosed

Dermatologists are clinicians who specialize in skin issues and can help diagnose and treat alopecia areata.

During an exam, they may ask about your medical history. They’ll want to know whether you have a family history of alopecia areata or other autoimmune and related conditions. They may also:

• Run blood tests to check vitamin and mineral levels and to screen for thyroid disease
• Send a hair sample off for analysis
• Take a biopsy (skin sample) to look for disease
• Check for skin infections

Treatment Options for Alopecia Areata

Usually, the main treatment goal is to manage the condition since it can’t be cured. Your alopecia treatment plan depends on how much hair you’ve lost, where you’ve lost it, and how long you’ve had symptoms.

Medications

A range of treatment options is available to adults and children ages 10 and older with hair loss, depending on symptom severity. These include:

• Contact immunotherapy — Topical treatment that aims to discourage the immune system from attacking hair follicles and encourage regrowth
• Corticosteroids — Medication that’s taken orally, injected, or rubbed into the skin to help calm inflammation and encourage hair regrowth
• Minoxidil — An over-the-counter topical medication or prescription oral medication that aims to encourage hair regrowth

Janus kinase (JAK) inhibitors are another treatment that calms the immune system and may help with regrowth in some people. Some are only approved for adults, while others are approved for people age 12 and older.

Sometimes, drug treatment isn’t recommended. If you’ve had one or two small bald spots for less than a year, many dermatologists may recommend that you wait and see what happens. Some people — especially children — will regrow hair without treatment.

Self-Care Strategies

Your healthcare team may also recommend gentle care of your scalp, as well as other self-care techniques. They may recommend:

• Improving your diet — Hair, skin, and nails need the right nutrients from your diet to grow and stay healthy. If you’re not sure how to improve your diet, talk to a nutritionist or dietitian.
• Using sun protection — Hair loss exposes more skin to the sun. Hats, bandanas, scarves, and sunglasses can help protect the body from sun exposure.
• Managing stress — Although researchers aren’t sure what triggers alopecia areata or relapses, major life stressors are a suspected factor. A mental health professional can help you learn coping techniques.
• Styling gently — Certain hair products and styling chemicals can be harsh and irritating. Ask your dermatologist about more gentle alternatives to the products you’re currently using.

Other Ways To Manage Hair Loss

If you’re worried about appearance or if treatments aren’t helpful, your dermatologist may suggest safe ways to hide your hair loss. How — and if — you disguise your hair loss is a personal decision, so it’s important to do what feels right to you.

Some people may learn new hair-styling techniques to hide hairless patches on their head. Those with extensive hair loss sometimes try a hair weave, wig, or scarf.

People who have lost eyelashes or eyebrows have similar options. Products like removable eyelashes or eyebrows can fill gaps or replace natural hair. Cosmetic tattoo artists may offer microblading, which uses semipermanent tattoo ink to create natural brows. Before looking into these options, confirm with your dermatologist that pigments or glues won’t harm your skin or interact with your medications.

Other people prefer embracing their hair loss, especially if they don’t want to undergo treatment or if treatment fails. They may shave the remainder of their hair completely and maintain a hairless look.

How To Cope With Alopecia Areata

Living with alopecia areata can feel difficult. It may impact how you feel about yourself and how you feel in your community. People with the condition often feel frustrated about how it affects their appearance and aren’t sure how to cope with its unpredictability or severity.

Talking to your community about alopecia areata can help you process challenging emotions and provide answers to your questions, but feelings can become overwhelming. If you’re not sure where to turn, ask your care team for professional support.

Join the Conversation

On MyAlopeciaTeam, people share their experiences with alopecia, get advice, and find support from others who understand.

What has been your experience with alopecia areata? Let others know in the comments below.