Alopecia areata is an autoimmune condition that causes hair loss, often in round or oval patches. It can affect anyone, but women may be more likely than men to develop it, according to the National Alopecia Areata Foundation.

This article discusses alopecia areata in females. Understanding what it looks like, why it happens, and what treatments are available can help you make informed decisions and feel more in control.

What Causes Alopecia Areata?

Alopecia areata is an autoimmune disease. In this condition, the immune system attacks healthy tissue — in this case, hair follicles.

Genetics

Research shows that alopecia areata can run in families. Having a close relative with alopecia areata or another autoimmune disease increases your risk. However, many females with alopecia areata don’t have a family history.

Age

Alopecia areata can happen at any age, from childhood through menopause and beyond. Many cases begin in childhood. Of the nearly seven million people in the United States with alopecia areata, about 20 percent are children.

Other Health Conditions

People with alopecia areata are more likely to have other immune-related conditions, including autoimmune conditions such as vitiligo or thyroid disease. Some people also have atopic (allergic) conditions such as eczema or asthma.

Possible Triggers

Some people report that their alopecia areata symptoms began after a viral illness, major stress, surgery, or hormonal changes. These events may act as triggers in people who are already genetically prone to alopecia areata, but they don’t directly cause the condition. Scientists are still working to understand exactly how this happens.

What Does Not Cause Alopecia Areata?

There are many myths about what causes alopecia areata. The condition is not contagious — you can’t catch it from someone else. It’s also not caused by hair products, tight hairstyles, hair dye, or poor hygiene.

Alopecia areata is different from other common types of alopecia in females. For example, female pattern hair loss — also called androgenic alopecia — usually causes gradual thinning on the top or crown of the scalp and rarely forms smooth bald patches. In contrast, alopecia areata often starts suddenly and causes well-defined areas of little to no hair.

What Does Alopecia Areata Look Like in Females?

The most common sign of alopecia areata is one or more smooth, round bald patches on the scalp. These patches may start small and grow over time. Other possible symptoms include:

• Changes in scalp color
• Short “exclamation point” hairs (wider at the top and thinner near the scalp)
• Tingling, itching, or mild burning before hair falls out
• Sudden hair shedding
• Nail changes, such as pitting (tiny dents), ridges, or brittleness

Sometimes hair is lost only on the scalp. Other times hair loss also affects the eyebrows, eyelashes, and body.

Can Symptoms Spread?

Yes. In some people, alopecia areata can progress instead of remaining limited to a few small patches. More extensive types of alopecia areata include:

• Alopecia totalis — Hair loss on the entire scalp
• Alopecia universalis — Hair loss across the entire body
• Ophiasis alopecia areata — Hair loss in a band along the lower back and sides of the scalp

It’s hard to predict how the condition will progress. Hair may grow back fully, partially, or not at all. Even after regrowth, hair can be lost again.

How Do Hair Texture and Styling Choices Affect Alopecia Areata?

Alopecia areata can affect people of all races and hair types. However, it may look different depending on hair texture and styling choices. For example:

• Patches may be less noticeable at first in tightly coiled or textured hair.
• Tight hairstyles can cause other types of hair loss.
• Heat or chemical treatments can lead to breakage, which may be mistaken for alopecia areata.

Hair styling choices don’t cause alopecia areata, but tight styles or frequent heat and chemical treatments can lead to other types of hair loss. Conditions like traction alopecia and central centrifugal cicatricial alopecia may look similar but have different causes and treatments. A dermatologist can help identify the type of hair loss and guide the next steps.

How Is Alopecia Areata Diagnosed?

A dermatologist usually diagnoses alopecia areata by examining your hair, scalp, and nails. They may also use a dermoscope, a tool that magnifies the scalp, to take a closer look at the hair follicles.

In some cases, a healthcare provider may order blood tests to check thyroid function or rule out other autoimmune conditions. Rarely, they may recommend a scalp biopsy or send a hair sample to a lab for analysis if the diagnosis is unclear.

Diagnosis also involves ruling out other causes of hair loss, like traction alopecia, telogen effluvium, and frontal fibrosing alopecia. Early diagnosis can help you explore treatment options sooner.

How Is Alopecia Areata Treated?

There’s no cure for alopecia areata, but several treatments may help promote regrowth or slow hair loss. These include:

• Corticosteroids — These medications reduce inflammation and calm the immune response. They may be given as injections (often used first for small, patchy areas and repeated every four to six weeks), topical creams or ointments, or a short course of oral medications.
• Minoxidil — This topical medication can help stimulate hair growth and is available over the counter. It’s often used with other treatments, as it may have limited benefit on its own, though low-dose oral minoxidil may also be used in some cases.
• Topical immunotherapy — This treatment involves applying a chemical to the scalp to create a mild allergic reaction, which may help “distract” the immune system and encourage hair regrowth. It’s usually used for more extensive hair loss under medical supervision.

Prescription Treatments for Severe Alopecia Areata

For more severe alopecia areata, some people may be treated with prescription pills called Janus kinase (JAK) inhibitors. JAK inhibitors can help hair grow back for some people, but they aren’t right for everyone and may require regular checkups and blood tests. A board-certified dermatologist can help you decide if this option makes sense for you.

Overall, it’s important to have realistic expectations. Even with treatment, regrowth can take months, hair may grow back white or fine at first, and some severe cases are harder to treat. Treatment decisions should be made with a dermatologist based on the extent of hair loss, your age, medical history, and personal goals.

Management of Eyebrow and Eyelash Loss

Losing eyebrows or eyelashes can be especially distressing — these hairs help protect the eyes and play an important role in facial expression. Treatment options may include topical medications. Cosmetic options may include microblading, brow pencils, and false eyelashes.

What Cosmetic Options Can Help With Alopecia Areata?

Certain cosmetic solutions may help you feel more confident while managing hair loss. Choosing whether to use any of the following options is a personal decision:

• Wigs
• Hair toppers
• Headscarves and wraps
• Hats or turbans

Some insurance companies may cover wigs when prescribed as a “cranial prosthesis.”

Moving Forward With Alopecia Areata

Alopecia areata is an autoimmune condition that causes unpredictable hair loss. It’s not your fault. It’s not caused by hair styling choices, and it’s not contagious.

While there is no cure yet, treatment options may help with hair regrowth. Cosmetic options and emotional support can also be important parts of care. With clear information, medical guidance, and support from others who understand, you can make choices that feel right for you.

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What has your experience been like as a woman with alopecia areata? Let others know in a comment below.