Alopecia Areata

Alopecia areata is an immune-induced disease that causes non-scarring hair loss. This can range from isolated patches on the scalp to complete scalp and body hair loss. It usually looks like smooth, round patches of hair loss on the scalp, with distinct edges. It can progress to total hair loss, or can remain patchy. People with alopecia areata can go through periods of remission, in which hair loss does not occur.

Alopecia areata happens when your immune system begins to identify your hair follicles as a risk to your health and attacks them. Researchers are still working to understand what causes this response. There may be a genetic component as well as environmental factors that trigger the condition. However, just because you have a genetic risk for developing alopecia areata doesn’t mean you will.

Alopecia areata is the second-most common type of hair loss. Approximately 2% of the population will experience alopecia areata at some point during their lives. It’s equally common in men and women, but is especially common for people with Asian ancestry.⁵

If you have a close relative with alopecia areata, you are at increased risk of developing the condition. This is especially true for people who first experience symptoms at an earlier age.

People with alopecia areata are more likely to have other autoimmune or inflammatory conditions. These include:

• Atopic dermatitis (eczema)
• Vitiligo
• Psoriasis
• Rheumatoid arthritis
• Systemic lupus erythematosus (lupus)
• Inflammatory bowel disease (IBD)
• Type 1 diabetes

Heavy smoking may also be a risk factor, although researchers don’t yet fully understand why this is.⁷

Alopecia areata does not always have the same symptoms and can show up differently. The three most common ways that Alopecia areata can show up are²:

• Patchy alopecia areata – The most common form of alopecia areata, involving small, random patches of hair loss (often on the scalp)
• Alopecia totalis – A severe form of the disease, in which you lose all or most of the hair on your scalp; this form is rare (about 5% of people)
• Alopecia universalis – A severe form of the disease, in which you experience near-total loss of hair on all parts of the body; this form is rare (about 1% of people)

58% of people have a mild to moderate form of the disease (patchy alopecia areata) and 42% have a severe form. In up to 25% of cases, patchy alopecia areata can progress to alopecia totalis.⁵

AA has an unpredictable disease course. Approximately 50% of patients with alopecia areata experience spontaneous remission within one year, though they may experience multiple episodes of relapse.⁶ Relapse and poorer response to treatment are more common for people with more severe versions of the disease, longer duration of hair loss, a younger age at first onset, a family history of alopecia areata and other autoimmune conditions.

There is currently no cure for alopecia areata. It rarely affects physical health, but it can have significant impacts on your psychological wellbeing.

While alopecia areata is not physically life-threatening, it may impact your psychosocial well-being. People with alopecia areata have experienced impact to self-esteem, confidence, anxiety, and depression so it is important to reach out to your care team and network to gain the support you need.

You may also be more sensitive to light and temperature and have an increased risk of sunburn. The loss of facial hair can also make it harder to keep irritants out of your eyes and nose.

You can talk with your care team about treatment options that may work best for you. In addition to medical treatment, there are many non-medical options for living with alopecia areata. These might include wigs, weaves or headscarves to cover hair loss, fake or tattooed eyebrows and fake eyelashes. To protect your eyes following eyelash loss, glasses can keep out dust. Sunglasses and hats, in addition to sunscreen, can protect exposed skin.

There are approved treatments for alopecia areata, and researchers continue to investigate potential new and more effective treatment. You can talk with your doctor about options for your treatment plan, including whether you may be a good candidate for a clinical trial.