Alopecia areata (AA) is a type of hair loss that happens when your immune system attacks your hair follicles. The term “alopecia” means hair loss, but not all types of alopecia are autoimmune related.

“Alopecia areata is a form of nonscarring hair loss,” explains Brooke Jackson, MD, a board-certified dermatologist and dermatologic surgeon based in Durham, North Carolina. “It is considered an autoimmune disease, one in which your body fights itself.”

Read on to learn the essential information you need to know about alopecia areata, including the symptoms, causes, treatment options, and more.

Common Questions & Answers

Can alopecia areata be cured?

There’s no cure for alopecia areata, but treatments may help promote hair regrowth. Some people will have multiple cycles of hair loss for life, but others may have only one.

What triggers alopecia areata?

There’s no single cause of alopecia areata, but it’s thought to be triggered by a combination of genetics and environmental factors, such as stress and cold weather.

Can stress lead to alopecia areata?

Stress isn’t a proven cause of alopecia areata, though it may trigger AA. There’s still debate whether stress could trigger an already-existing autoimmune condition, because of the number of people who report losing their hair shortly after major life-stress events.

Is hair regrowth possible after alopecia areata?

Your dermatologist can help you determine the best options. Some people may see full hair regrowth after alopecia areata, but other cases of hair loss may be permanent. It’s also possible to see hair regrowth then lose some of it again.

Is alopecia areata in women different from the disease in men?

Overall, women and men develop alopecia areata equally, with potentially extensive hair loss. However, men may be more likely to see facial hair loss, such as patchy beard.

Signs and Symptoms of Alopecia Areata

Sudden hair loss is the first and most common sign of alopecia areata. Some people with AA also report feeling itching, burning, or tingling sensations before they lose their hair.

However, most people with AA don’t have any noticeable symptoms other than hair loss, and may be in good health overall.

When you have alopecia areata, you may notice your hair falling off your scalp in round clumps, which may be up to the size of a quarter each. This is due to inflammation around the hair follicles, which makes them unable to support strands of hair.

The extent and location of alopecia areata may vary based on both severity and subtype. In some cases, only small patches of hair may be lost. A more severe type of alopecia, called alopecia areata totalis, may cause more hair loss across the entire scalp.

Some people may lose hair from their brows, lashes, and body from a rare subtype called alopecia universalis.

In addition, between 10 and 20 percent of people with alopecia areata see nail changes. This may include dry and brittle nails, as well as red nails. Your nails may also have pits, and feel extremely rough to the touch.

Such related nail changes tend to be associated with more severe cases of alopecia areata, in which you may also have extensive hair loss.

Causes and Risk Factors of Alopecia Areata

The exact cause of alopecia areata isn’t known, but it’s thought that this autoimmune disease occurs more frequently in people who have a family history of alopecia areata or other autoimmune disorders such as thyroid disease, lupus, or diabetes.

“In the case of AA, the body does not recognize the hair follicle as its own and mounts an immune response against what it believes is a foreign object, causing hair loss,” says Dr. Jackson.

It’s thought that your genes, along with factors in your environment, could also trigger the development of alopecia areata. Also, AA is not contagious.

Alopecia areata may develop at any age, but most people who have this autoimmune disease start having symptoms as a child or a teenager.

Also, the younger you are when diagnosed with AA, the more severe and progressive the condition may be.

How Is Alopecia Areata Diagnosed?

Alopecia areata is primarily diagnosed with a physical exam. Your dermatologist will check for signs of hair loss on your scalp, face, and body, as well as changes in your nails. Additionally, they may order blood tests to determine whether you have other autoimmune diseases, for example, thyroid issues, if the case warrants.

Even if your dermatologist suspects alopecia areata, they may use additional diagnostic tests to rule out other conditions. This may include pulling a few remaining hairs from your scalp to examine their shape under a microscope, or punching out a small patch of skin to send to a lab for further analysis (called a skin biopsy).

Prognosis of Alopecia Areata

Alopecia areata is considered an unpredictable condition. While your hair may grow back, it’s not possible to determine whether hair regrowth is permanent, or if there’s a risk that it may fall out again.

On the flipside, some people with alopecia areata have only one episode of hair loss in their lifetime.

Duration of Alopecia Areata

The exact duration of alopecia areata is unknown. Your hair may grow back, but it’s possible for this condition to return. You may also develop other types of autoimmune diseases in the future, so it’s important that your doctor monitors your condition and orders regular lab tests.

Also, the American Academy of Dermatology Association says that about half of all children and teens who have AA will start seeing hair regrowth within a year without treatment. However, AA may be a lifelong condition for some people, with cycles of hair loss and hair regrowth.

Treatment and Medication Options for Alopecia Areata

While the exact treatment for alopecia areata may depend on the severity and type, your dermatologist will most likely recommend a combination of medications as well as lifestyle changes that may help you feel better.

Medication Options

Alopecia areata may be treated with a combination of medications that either help reduce the immune system’s attack on hair follicles, or help to promote hair regrowth. These may include the following:

Corticosteroids Also known as simply “steroids,” medications such as prednisone may help reduce inflammation and your immune system’s attack on the hair follicles. These may be oral, topical, or injected, and the results may be gradual.
Minoxidil (Rogaine) It’s typically sold over the counter for pattern baldness, but minoxidil may also help with hair regrowth in alopecia areata. It can take at least 12 weeks to see results, and it’s often combined with other therapies for the best results.
JAK inhibitors These oral medications, prescribed for rheumatoid arthritis and a number of other conditions, are considered a breakthrough in alopecia areata treatment, and may be particularly helpful for people with severe hair loss who haven’t had success with other therapies.
Olumiant (baricitinib) is the only JAK inhibitor approved by the U.S. Food and Drug Administration (FDA) for the treatment of severe alopecia areata in adults. While considered safe and effective, Olumiant comes with a “boxed” warning about rare but potentially serious complications.

Besides these medications, your dermatologist may recommend others based on the extent of your hair loss. For example, some topical drugs can help promote eyebrow and eyelash hair regrowth.

Alternative and Complementary Therapies

While there aren’t any known alternative or complementary therapies that will effectively treat alopecia areata, some of these lifestyle changes could help you feel better more generally:

Eat a balanced diet.
Avoid fad diets, or “yo-yo dieting,” which could lead to unrelated problems with hair loss.
Take time each day to relax to help reduce overall stress.
Experiment with different coverings, such as wigs, scarves, and hats to protect your head from the sun.
If you wish, experiment with cosmetics to help camouflage the appearance of hair loss.

Complications of Alopecia Areata

Alopecia areata can lead to stress and anxiety over the unpredictability of this condition. It’s important to find support where you can, including from your doctor, family, and friends. You may also consider joining a support group, where you can connect with others going through similar experiences.

Other potential complications tied to alopecia areata include:

Sunburns
Increased risk for developing skin cancer
Illnesses and irritation from germs and particles getting in your eyes, nose, and ears

BIPOC and Alopecia Areata

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, alopecia areata generally affects all races and ethnic groups.

However, emerging research is revealing possible disparities, as discussed below.

Black Americans and Alopecia Areata

One recent epidemiological study explored racial differences of alopecia areata and found that in the United States, Black Americans were more likely to experience AA compared with white Americans. Additionally, Asian Americans were found to be less likely to develop AA than white Americans.

Hispanic Americans and Alopecia Areata

While more studies are needed to explore associations between race and alopecia areata, another study, which included self-reported alopecia areata in women in the United States, found higher lifetime rates among Black and Hispanic Americans.

Alopecia Areata Resources We Love

Favorite Orgs for Essential Alopecia Areata Info

National Alopecia Areata Foundation (NAAF)

Since its founding in 1981, the NAAF has served those affected by alopecia areata as well as their families through a wealth of educational resources and advocacy opportunities. Additionally, the NAAF helps support research for potential new treatments. Learn more about the NAAF’s Treatment Development Program.

American Academy of Dermatology Association (AAD)

As the largest dermatologic association in the United States, the AAD offers expert-written information about hair and skin diseases, including educational resources about alopecia. The AAD has also existed since 1938, and has since become a valuable membership resource for dermatologists across the country.

Favorite Alternative Medicine Resource

National Center for Complementary and Integrative Health (NCCIH)

If you’re interested in the latest science behind mind-body practices and herbal remedies related to your health, you can consider bookmarking the NCCIH’s website. There aren’t any known alternative therapies that will cure alopecia areata, but a healthy diet and lifestyle may help. For example, if your dermatologist recommends stress management, start at the NCCIH's page on mind and body approaches to stress and anxiety.

Favorite Online Support Networks

NAAF Support Group Network

The leading alopecia areata advocacy and education organization also offers worldwide support groups and networking opportunities. Here, you can find out how you can contact NAAF for their most recent list of support groups, as well as event opportunities to help stay connected.

Children’s Alopecia Project (CAP)

As a nonprofit organization dedicated to help children with alopecia and their families, CAP also offers several events where children can connect with their peers for support. Check out CAP’s latest offerings, including their summer camps.

Favorite Site for Alopecia Areata Products

NAAF’s Alopecia Areata Marketplace

From headwear and hairpieces, to books and other educational tools, you can consider the NAAF’s marketplace as a one-stop shop for alopecia areata-related products. Here, the NAAF offers a list of approved vendors where you can also donate a portion of any costs directly back to NAAF.

Favorite Resource for Diet Advice

The Nutrition Source from Harvard School of Public Health

Although there’s no alopecia areata diet per se, we know that eating a balanced diet full of anti-inflammatory foods can help you feel better. The Nutrition Source offers multiple pieces of advice that can help you get started, including information about macronutrients and healthy recipes. Consider checking out their review of anti-inflammatory diets as a starting point.

Favorite Resource for Becoming an Advocate

NAAF

As the largest alopecia areata nonprofit, it’s no surprise that we consider the NAAF the best source for getting started with advocacy. The group makes the process less intimidating with a wealth of resources on how to contact legislators, schools, and the media. Sign up for its email list to access more information.