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Treatment of alopecia areata

Alopecia areata is a particular type of hair loss that typically causes patches of baldness. In some cases, total baldness occurs. In many cases the hair re-grows, typically after several months, whilst in some cases hair loss may be permanent. Treatments to promote hair re-growth work in some cases.


Alopecia means loss of hair or baldness. There are several different causes and patterns of alopecia. Alopecia areata is one type of hair loss and estimates of the number of people affected by it vary between 1 in 1,000 to 2 in 100. Alopecia areata can occur at any age but most cases first develop in teenagers years. In about six out of 10 cases the first patch of hair loss develops before the age of 20 years. Males and females are equally affected within younger age groups, whereas those affected late in life are mainly women. Usually the condition tends to be milder when it first develops at an older age.


The typical pattern for alopecia areata, is for one or more bald patches to appear in the scalp. These tend to be round in shape and about the size of a large coin. They tend to develop quite quickly and a relative, friend or hairdresser may be the first person to notice the bald patch or patches on a patient's scalp.

Apart from the bald patch(es), the scalp usually looks healthy and there is no scarring. Occasionally, there may be some mild redness, mild scaling, mild burning, or a slightly itchy feeling on the bald patch. When a bald patch first develops, it is difficult to predict how it will progress. The following, are the main ways it may progress:

l Quite often the bald patch or patches re-grow hair within a few months. If hair grows back, it may not have its usual colour at first and may look grey or white for a while. The usual colour eventually returns, however, after several months.

l Sometimes one or more bald patches develop, a few weeks after the first one. Sometimes the first bald patch is re-growing hair whilst a new bald patch is developing. It can then appear as if small bald patches rotate around different areas of the scalp over time.

l Sometimes several small bald patches develop and merge into a larger bald area.

l Patches of body hair, the beard area, the eyebrows or even eyelashes may be affected in some cases.

l Large bald patches develop in some people and some loose all their scalp hair. This is called alopecia totalis.

l In a small number of cases, all scalp hair, body hair, the beard area, eyebrows and eyelashes are lost. This is called alopecia universalis.

l The nails are affected in about one in five cases and can become pitted or ridged.


Alopecia areata is thought to be an auto-immune disease. The immune system makes white blood cells (lymphocytes) and antibodies to protect against foreign objects such as bacteria and viruses. In auto-immune diseases the immune system mistakes part of the body as foreign. In people with alopecia areata, many white blood cells gather around the affected hair root which is mistaken as foreign, subsequently causing inflammation which then leads to hairs becoming weak and falling out, causing bald patches.

It is not known why alopecia areata or other auto-immune diseases occur. It is thought, however, that something triggers the immune system to react against one or more of the body's own tissues. Possible triggers include viruses, infection, medication or other environmental factors. There is also an inherited factor that makes some people more prone to auto-immune diseases. About one in four people with alopecia areata have a close relative who is affected.

Patients with alopecia areata also have a slightly higher than average chance of developing other auto-immune diseases such as thyroid disorders, pernicious anaemia and vitiligo. It is important to stress, however, that most people with alopecia areata do not develop any of these other conditions.


Mild cases of alopecia areata often resolve without treatment and this usually occurs within a few months to a year. In some cases, patchy baldness may come and go over many months or years. If less than half of the scalp is affected and no treatment is started, there is about an eight in 10 chance of full hair re-growth within one year. With more extensive hair loss, it is less likely that hair will re-grow. However, even if a patient's hair re-grows after one episode of alopecia, it is common to have one or more recurrences of the condition throughout one's life.

Treatment in the form of steroidal injections or topical steroidal creams as well as minoxidil solution, applied topically can help to promote hair re-growth in certain cases.

Topical immunotherapy is by far the most effective treatment for those with extensive alopecia areata, however this is only available from certain skin specialists and thus requires referral from a general practitioner (GP) or dermatologist.

If you think you may be suffering from this condition you should attend your GP for advice and counselling. Otherwise further information may be obtained from visiting