Alopecia areata
Patient education from NorCal Hair Doctor™
What is alopecia areata
Alopecia areata is a condition in which the immune system mistakenly attacks hair follicles, the small structures in the skin that grow hair. This can cause sudden hair loss. The follicles usually remain alive, so hair may grow back, either on its own or with treatment.
What does it look like
It often begins as one or more smooth, round or oval bald patches on the scalp. It can also affect the beard, eyebrows, eyelashes, or other body hair. Some people develop widespread thinning rather than distinct patches. Tiny dents or other changes in the nails may also occur. Loss of all scalp hair is called alopecia totalis; loss of scalp and body hair is called alopecia universalis.
Why does it happen
Alopecia areata can affect children and adults of any background. Genes and changes in immune activity play a role, but the exact trigger is often unknown. It is not contagious and is not caused by poor hygiene. It is not your fault. Stress may contribute in some people, but it is not the only explanation.
How is it diagnosed
Dr. Agbai reviews your history and examines your hair, scalp, and sometimes your nails. A magnifying tool called a dermatoscope may help identify the pattern. Blood tests or a small scalp biopsy are sometimes needed when another condition is suspected; not everyone needs these tests.
What treatments can help
Treatment depends on your age, the amount and location of hair loss, and your health. Options may include corticosteroid injections into affected patches, prescription topical corticosteroids, or other medicines that reduce the immune attack. For selected patients with severe disease, oral medicines called JAK inhibitors may be considered after discussing risks and monitoring. Minoxidil may sometimes be added to support regrowth, but it does not address the immune attack by itself.
What should I expect
The course is unpredictable. Some people regrow hair without treatment; others need ongoing care. Hair loss may return after regrowth, and no treatment guarantees a permanent cure. Medical treatment is the main approach; hair transplantation is generally not recommended for alopecia areata because the immune system can also affect transplanted hairs.
Getting support
Seek an evaluation for new bald patches, eyebrow or eyelash loss, or sudden shedding. Protect exposed scalp from the sun and use gentle hair care. Wigs, hairpieces, and cosmetic camouflage are optional tools for comfort and confidence. If hair loss affects your mood or daily life, tell your physician so support can be part of your care.
Learn more: American Academy of Dermatology — aad.org/public/diseases/hair-loss/types/alopecia; National Alopecia Areata Foundation — naaf.org.