Alopecia areata

Alopecia areata is an autoimmune disease that causes unpredictably thinning hair.Hair comes out in tiny patches, around the size of a quarter, in the vast majority of instances. Hair loss is typically limited to a few patches in most people, however, it can be more severe in certain situations.

It can cause full hair loss on the scalp (alopecia totalis) or, in severe cases, the whole body (alopecia Universalis) (alopecia Universalis).

Everything you should know about Alopecia areata

Alopecia areata is thought to be an autoimmune condition caused by a breach in the hair follicles’ immunological privilege. A history of the disease in one’s family is also a risk factor. If one of the identical twins is afflicted, the other has a 50% probability of being afflicted as well. The fundamental mechanism includes the body’s failure to recognize its cells, which leads to the hair follicle being destroyed by the immune system.

Hair loss varies in intensity from person to person. Only a few spots are lost for some people. Others have suffered a significant setback. Hair can come back in certain cases, but it will eventually fall out again. Hair regrows completely in others.

This disorder comes in a variety of forms. The most prevalent kind of alopecia areata is alopecia areata, although there are other, less frequent forms as well.

Alopecia areata is a disease that is caused by the immune system. When the immune system misidentifies healthy cells as foreign invaders, an autoimmune disorder occurs. The immune system protects your body from external invaders like viruses and bacteria in normal circumstances.

Your immune system, on the other hand, assaults your hair follicles when you have alopecia areata. The structures that hairs develop from are known as hair follicles. Hair loss occurs when follicles shrink and cease to produce hair.

The etiology of this disease is unknown to researchers.

People with a family history of autoimmune diseases like type 1 diabetes or rheumatoid arthritis are more likely to develop it. This is why some researchers believe genetics may play a role in alopecia areata development.

They also believe that certain environmental factors are necessary to cause alopecia areata in people who are genetically predisposed to the condition.


Small bald patches are common initial signs of alopecia areata. The underlying skin is free of scars and seems to be normal on the surface. These patches come in a variety of forms, but the most common are round or oval. Alopecia areata is a hair loss condition that most commonly affects the scalp and beard, although it can affect any region of the body that has hair. Hair loss and regeneration may occur simultaneously in different regions of the skin. The illness may go into remission for a short period or remain stable. In youngsters, it is quite frequent.

It may tickle or hurt where you’re losing hair. Hair loss usually occurs on one side of the scalp more than the other, and it happens within a short time.

Exclamation point hairs, which are thinner along the length of the strand closer to the base and give the strand a distinctive exclamation point look, are common. These hairs are short (3–4 mm) and can be observed around bald areas.

Only a few healthy hairs should be pulled out at a time, and torn hair should not be spread equally throughout the strained part of the scalp. Hair tends to pull out more readily around the border of the patch, where the follicles are already being attacked by the immune system, than away from the patch, where they are still healthy, in cases of alopecia areata.

Pitting or trachyonychia can appear on the nails.



Medical therapy might involve coping techniques for the mental problems that may occur in addition to hair loss (the physical part of the illness). Counseling and support groups are popular recommendations for dealing with the emotional side of hair loss, which may have a significant impact on confidence and cause worry (at worst, even depression).

To prevent emotional problems and social isolation, counselors or those with their conditions (within a safe environment) might rely heavily on who can provide comfort, advice, or even helpful suggestions to improve their appearance (such as safe to use hair-colored powders and creams to mask bald patches or permanent make-up techniques to replace missing eye-brows).


People under the age of 30 are more likely to have this issue. People with a personal or family history of these issues are also more likely to develop them:

  • Alopecia areata
  • Having a higher risk of developing reactive skin disorders or allergic responses
  • Having a different autoimmune disease, such as lupus.

Yes, heredity is a factor. Alopecia areata is a polygenic illness that involves the input of multiple genes inherited from both parents, as well as a contribution from the environment, to cause the condition. Most children with alopecia areata, on the other hand, do not have a parent who has the condition, and the great majority of parents who have the disease do not pass it on to their children. 

Because alopecia areata is a complicated illness with several genes contributing to risk, there is no method to precisely assess the chance of passing it on to your offspring. Researchers believe that certain individuals may predisposition to the disease via several genes. A child is extremely unlikely to inherit all of the genes required to predispose him or her to the illness.

Alopecia areata can develop even if you have the appropriate (or wrong) gene combination. The concordance rate is just 55% with identical twins who share all of the same genes. In other words, if one twin has the illness, the other twin only has a 55% chance of getting it. 

This suggests that, in addition to genetics, other environmental variables are necessary for illness onset. This is why one twin gets alopecia areata while the other doesn’t. Environmental causes that cause alopecia areata are currently being investigated.


Alopecia areata has no known cure, although doctors might recommend treatments to help hair regrow more quickly. Corticosteroids, which are strong anti-inflammatory medications that can inhibit the immune system, are the most frequent method of alopecia areata therapy.

Alopecia areata isn’t painful or contagious, and it doesn’t affect one’s ability to work, study, or socialize. However, it might induce abrupt and severe hair loss, which can harm your self-esteem and confidence.

Alopecia areata is a condition in which the immune system erroneously assaults the hair follicles for unknown causes. Fortunately, the follicles maintain their capacity to regenerate hair, and in most cases, hair loss is temporary.

Whether your hair loss is caused by hormones or an autoimmune condition, you can regenerate it by taking new medicines and changing your diet if you start therapy early. Hair loss is irreversible once the hair follicle is damaged, according to a 2017 study published in Nature Reviews Disease Primers.

A family pattern has been postulated in 20% of instances, suggesting that certain people may have a hereditary susceptibility to alopecia areata. A genetic predisposition indicates that a person may possess a disease gene, but it may not be manifested unless the sickness is triggered by something in the environment.

The oils and lotions can cost as little as INR 500 approx., and the therapy and testing will vary depending on the clinic or medical institution where you are receiving treatment. Always choose a reputable clinic when choosing a hospital, and make sure your trichologist has expertise in treating Alopecia Areata.

During your therapy, you will be able to resume your usual activities. These therapies would be administered in the form of medicines, oils, or lotions. As a result, your usual work life will be unaffected. The medication’s outcome may also be influenced by the individual’s medical condition. After six months, the average noticeable outcomes might begin to show.

The treatment’s long-term effectiveness is determined by the patient’s medical state. The problem fades away in a few people, but it might return after a short break, while hair growth in others can be permanent. Consult your doctor about any possible problems you may be experiencing and the best treatment options.

You may have some adverse effects because they are artificially stimulating the regrowth of your hair follicles. These symptoms might range from scalp irritation to redness in the area. Also, if you’re using medicines or hair-growth tablets, they may have an impact on your reproductive organs and sex life. Before you go for the medicines, make sure you’ve discussed all of your concerns with the doctor.

Alopecia areata generally starts as patchy hair loss in one or more coin-sized (usually round or oval) patches on the scalp or other hair-producing areas of the body, such as the beard, eyebrows, eyelashes, or extremities (arms, legs, hands, and feet).

Main Forms of Alopecia Areata

Listed below are the main forms of Alopecia Areata.

  • Alopecia areata (patchy)

Alopecia areata (patchy) is a hair-growing condition characterized by one or more coin-sized (typically round or oval) patches on the scalp or other parts of the body. This kind can progress to alopecia totalis (hair loss all over the scalp) or alopecia Universalis (hair loss all over the body), although it usually remains spotty.

  • Persistent patchy alopecia areata

Patchy scalp hair loss that persists over time without progressing to total or Universalis alopecia areata is known as persistent patchy alopecia areata.

  • Alopecia totalis

Hair loss occurs across the scalp in alopecia totalis.

  • Alopecia Universalis 

Alopecia Universalis is a kind of alopecia totalis that has progressed further. This kind causes hair loss all over the body, including the scalp, face, eyebrows, and eyelashes (including pubic hair).

Other Forms of Alopecia Areata 

Some other forms of Alopecia Areata include:

  • Diffuse Alopecia areata

Hair thinning all across the scalp is a symptom of diffuse alopecia areata. Because it resembles other types of hair loss, such as telogen effluvium or male or female pattern hair loss, it can be difficult to diagnose.

  • Ophiasis alopecia

Hair loss in Ophiasis alopecia areata takes the form of a band around the sides and lower back of the head (known as the occipital region). Because it does not react to treatment as fast as ophiasis alopecia areata, it is more difficult to cure.

It’s critical to understand more about AA and dispel these fallacies as you begin your therapy.

  • Myth 1

If you use AA, you’ll lose your hair altogether. According to DUCRAY Laboratories Dermatologiques, while uncommon kinds of AA cause complete hair loss on the head or throughout the body, the most frequent type of hair loss is more localized and mild.

  • Myth 2

You will never be able to regrow your hair. Scarring alopecia is a rare kind of alopecia that can lead to irreversible hair loss if diagnosed too late, according to Pichardo. Treatments for AA have been shown to stimulate hair regeneration in persons with the disease, however, new hair is not always permanent. Alopecia areata is non-scarring alopecia.

  • Myth 3

AA is a cancerous condition. This isn’t correct. Stress is the most prevalent sign of AA, which is an autoimmune illness. According to a Mayo Clinic article published in 2020, several diseases and medical treatments, such as chemotherapy for cancer, can cause hair loss all over the body, although the hair generally comes back.

  • Myth 4

Alcoholism is infectious. According to Pichardo, hair loss disorders are typically not infectious, except for a fungal scalp illness called tinea capitis.

  • Intralesional Corticosteroid injections

Corticosteroids are injected into exposed areas of skin with a small needle in this technique of therapy, which is the most frequent type of treatment for alopecia areata. A dermatologist would generally provide these injections every four to six weeks.

Corticosteroid injections generally result in new hair growth, which is evident after four weeks. This type of therapy has a small number of documented adverse effects.

  • Topical Corticosteroid

Corticosteroids are considered to reduce inflammation surrounding the hair follicle in alopecia areata. Topical steroids are available in a variety of brands, strengths, and forms, including solutions, lotions, foams, creams, and ointments.

Hair loss is reduced when topical steroids are used, according to studies. Furthermore, the application of very powerful topical corticosteroids has been shown to enhance regrowth by roughly 25%. They can be useful as a supplement to other medicines, particularly for treating youngsters with alopecia areata.

How to diagnose alopecia areata

Alopecia areata can be diagnosed by analyzing the degree of your hair loss and studying a few hair samples under a microscope.

A scalp biopsy may be performed by your doctor to rule out other causes of hair loss, such as fungal diseases such as tinea capitis. Your doctor will take a tiny sample of skin from your scalp for examination during a scalp biopsy.

If additional autoimmune diseases are suspected, blood testing can be ordered.

The type of blood test that is conducted is determined by the disease that the doctor believes is present. A doctor, on the other hand, will almost certainly do tests to see whether there are any aberrant antibodies present. If you have these antibodies in your blood, you probably have an autoimmune disease.

The following are some more blood tests that can be used to rule out other conditions:

  • Erythrocyte sedimentation rate and C-reactive protein
  • Levels of iron
  • An antinuclear antibody test is a type of blood test that looks for antibodies that attack
  • Hormones produced by the thyroid
  • Testosterone (free and total)
  • Luteinizing hormone and follicle-stimulating hormone are two hormones that stimulate the development of new follicles.


Treatments with therapies and lasers

Photochemotherapy or phototherapy are additional terms for light therapy. It’s a form of radiation therapy that combines the use of psoralens, an oral medicine, with UV light.

Topical medications

To assist encourage hair development, massage medicines into your scalp. Over-the-counter (OTC) and prescription medicines are available:

  • Minoxidil (Rogaine) is an over-the-counter product that should be applied to the scalp, brows, and beard twice a day. It’s largely risk-free, although results might take up to a year. Only people with limited alopecia areata may benefit from it, according to the evidence.
  • Anthralin (Dritho-Scalp) is a hair-regrowth stimulant that irritates the skin.
  • Clobetasol (Impoyz), foams, lotions, and ointments containing corticosteroids are considered to reduce inflammation in the hair follicle.
  • Topical immunotherapy is a method that involves applying a substance to the skin, such as diphencyprone, to cause an allergic reaction. The rash, which looks like poison oak, may cause new hair growth within six months, but you’ll need to keep the therapy going to keep the regeneration going.


For moderate, patchy alopecia, steroid injections are a frequent treatment option to assist hair to regrow on bald areas. The steroid is injected into the afflicted areas’ exposed skin with tiny needles.

To regenerate hair, the procedure must be repeated every one to two months. It doesn’t stop fresh hair loss from happening.

Oral medications

Cortisone pills are occasionally prescribed for severe alopecia, but because of the risk of side effects, you should consult a doctor before using them.

Another alternative is to take oral immunosuppressants such as methotrexate or cyclosporine. They operate by inhibiting the immune system’s reaction, but they can’t be taken for long periods because of the danger of side effects include high blood pressure, liver and kidney damage, as well as an increased risk of severe infections and malignancies.

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