Oops, I Shed It Again: What You Need to Know About Alopecia Areata

Experiencing hair loss can be a distressing ordeal, and one common form is alopecia areata. The word "alopecia" refers to hair loss or baldness, while "areata" means it shows up in small, random patches. If you've noticed patchy areas and feel worried, you're not alone. In this blog, we'll break down the basics of alopecia areata in a simple, straightforward way.

Alopecia areata is an autoimmune disorder. This means that your immune system, which typically protects your body against infections and foreign substances, inadvertently targets the hair follicles, resulting in uneven hair loss. These patches are usually small, round, and smooth, often affecting the scalp. In addition to your scalp, alopecia areata can also cause hair loss on your face, beard, eyelashes, and even all over your body in some severe cases. It can affect your nails and, in rare instances, parts of your eye, too. While the hair follicles aren’t permanently damaged, they temporarily stop producing hair. This often results in smooth, round patches of hair loss on the scalp or other areas with hair, which can develop fairly quickly. It is important to note that this condition is not life-threatening or contagious. 

Alopecia areata comes in different types, depending on how much hair is lost and the symptoms involved:

• Patchy alopecia areata: The most prevalent type, characterised by one or more circular patches of hair loss on the scalp or other parts of the body.
• Alopecia totalis: This type involves complete hair loss on the scalp.
• Alopecia universalis: In this form, all hair on the body is lost, including scalp, eyebrows, eyelashes, and body hair.
• Diffuse alopecia areata: Hair thins suddenly across the entire scalp, resembling typical male or female pattern hair loss.
• Ophiasis alopecia: This form causes hair loss in a band-like pattern around the sides and back of the scalp.

Alopecia Areata can impact individuals of any age, gender, ethnicity, or race. However, it most commonly appears before the age of 30. People with a family history of the condition are more susceptible because of genetic influences.

Conditions such as psoriasis, thyroid disease, vitiligo, and allergic conditions like hay fever and eczema, as well as emotional stress, can increase the risk of alopecia areata. Nutrient deficiencies, including vitamin D, B3, zinc, iron, biotin, and amino acids, may also contribute to the condition.

Alopecia areata (AA) affects approximately 2% of the global population, according to both population-based and hospital-based studies. However, in India, it accounts for 0.7% to 1% of the total population.

The primary and most often the only symptom of alopecia areata is the loss of hair, which can manifest in several ways:

• Patchy hair loss: You may notice small, round, smooth patches of baldness on your scalp or other parts of your body.
• Bald spot formation: These patches can grow larger and merge into a single bald spot.
• Hair growth and loss cycle: Hair may grow back in one area while falling out in another.
• Rapid hair loss: You might experience a significant amount of hair loss over a short period.
• Weather impact: Hair loss may worsen in cold weather.
• Nail changes: In some cases, particularly with extensive hair loss, fingernails and toenails may become red, brittle, and pitted, developing tiny dents, ridges, or white spots.

Additional symptoms include:

• Exclamation point hairs: Short, broken hairs around the edges of the bald patches that are narrower at the base than at the tip.
• Sensations before hair loss: Right before the hair falls out, you may feel tingling, itching, or a burning sensation in the affected areas.
• Progressive hair loss: In severe cases, hair loss can extend to the entire scalp (known as alopecia totalis) or the entire body (alopecia universalis), although this is rare.

While hair may regrow in some areas, it could initially appear grey or white. The regrowth process varies, and new patches of hair loss can develop over time.

The exact cause is still under investigation, but alopecia areata is known to be an autoimmune disorder where the immune system incorrectly attacks hair follicles. Genetics play a very critical role; individuals with a family history of the condition are at higher risk.

Environmental triggers, such as physical or emotional stress and viral infections, may also initiate the disease in genetically predisposed individuals. Researchers are uncertain about the specific triggers, suspecting it could be a combination of internal factors (like infections) and external factors (like environmental influences). About 20% of people with alopecia areata have a family member with the condition, and the risk is greater if a close relative loses their hair before age 30.

Yes, hair can regrow, especially in cases with a few patches of hair loss. However, relapses are expected, with hair regrowing and falling out again, often within a year. These cycles can repeat throughout life.

Dr Rajneesh Kanwat, Consultant Dermatologist at Jain Samadhi Hospital, Tohana, Haryana, explains that hair regrowth is often possible, but it depends on the severity of the condition. "Usually, hair regrows in most cases, but in large-area involvement like in alopecia universalis, complete regrowth may not always be possible, and recurrence of the disease is another common issue," he says. Patients should be aware that the condition can be unpredictable, and managing expectations is important.

There are no guaranteed ways to prevent alopecia areata. However, there are a few steps you can take to promote overall hair and scalp health. Here are some friendly tips:

• Manage stress: Since stress can be a trigger, finding ways to relax and manage stress — like yoga, meditation, or spending time with loved ones — can be beneficial.
• Eat a balanced diet: Nutrient-rich foods support overall health. Incorporate plenty of fruits, vegetables, and proteins into your meals.
• Gentle Hair Care: Be kind to your hair. Avoid harsh treatments and opt for gentle hair products. This can help keep your hair follicles healthy.

While there’s no permanent cure for Alopecia Areata, several treatments can help manage the condition and promote hair regrowth. Here are the most common options:

• Injections: These are used to reduce inflammation and calm the immune response around hair follicles, helping to encourage hair regrowth in patchy areas.
• Topical applications: Creams or solutions applied directly to the scalp aim to stimulate hair growth in areas where hair has been lost.
• Immune system modulation: Special treatments are applied to the skin to alter the immune response, promoting hair regrowth by changing how the body reacts to hair follicles.
• Platelet-based therapy: This involves using a concentration of platelets from your blood, which is injected into the scalp to boost natural hair growth.
• Other approaches: Depending on the severity of hair loss, different treatments, including topical solutions or internal medications, can help support and stimulate hair regrowth.

According to Dr Rajneesh Kanwat, consultant dermatologist, the treatment for alopecia areata depends on various factors, such as associated autoimmune diseases, the area of involvement, and the duration of the condition. Dr Kanwat says, “If a small area is involved, local injections could be helpful.” He adds, “For large areas of involvement, oral medications are often required.”  Dr Kanwat also highlights newer treatments, stating, “Newer treatments have shown good results, especially in large area involvement like alopecia universalis.”

Hair loss can be emotionally challenging, so many patients benefit from psychological support alongside their medical treatments. Connecting with support groups or a mental health professional can be helpful during this time.

Managing hair loss can significantly impact mental well-being. Dr Rajneesh Kanwat mentions that people handle hair loss in different ways. Some may choose to wear wigs or use camouflage techniques to cover bald spots, while others may opt not to hide them. Finding an effective coping strategy, whether through mental health support or cosmetic solutions, is essential for those affected by alopecia areata.

Talk to a dermatologist to develop a treatment plan that is most suitable for your needs.

Understanding alopecia areata can be a vital step in navigating this condition, whether for yourself or someone you care about. While it may lead to some unexpected changes, remember that it’s not life-threatening and can affect anyone. By recognising the symptoms and causes, you can take steps to support your hair and scalp health. If you notice patches of hair loss, a dermatologist can provide valuable guidance and treatment options tailored to your needs. Let’s embrace the conversation around alopecia areata and support one another.

Alopecia Areata causes hair loss in small, circular patches, typically on the scalp, though it can affect other body areas like the beard, eyebrows, and eyelashes. It occurs when the immune system incorrectly targets hair follicles, causing hair loss. Although it doesn’t cause physical pain or other health problems, it can lead to emotional distress due to its effect on appearance.

Alopecia Areata is quite common and affects around two per cent of the global population at some point in their lives. In India, it affects approximately 0.7-1% of the population.

Yes, hair can regrow after alopecia areata. In many cases, hair grows back within a few months, though it may initially appear white or grey. However, the condition is unpredictable — some individuals may experience complete hair regrowth, while others may continue to lose hair or see new bald patches form.

If you have alopecia areata, expect varying degrees of hair loss, typically in round patches. While hair regrowth may occur, it can also fall out again in different areas. Due to its impact on appearance, the condition can result in psychological impacts, such as anxiety or depression. Consulting a dermatologist is important for managing symptoms and exploring treatment options for hair regrowth and emotional support.

Living with alopecia areata requires both physical and emotional care.  

Protect your scalp and skin: Use sunscreen or wear wigs, hats, or scarves to shield exposed areas from the sun.

Cosmetic care: Makeup can help conceal hair loss. Artificial eyelashes or eyebrow pencils can restore appearance if you've lost lashes or brows.

Wear sunglasses: Protect your eyes from sunlight and debris if you've lost your eyelashes.

Balanced diet: A nutrient-rich diet like the Mediterranean diet, rich in fruits, vegetables, and proteins, may support hair health. Consider vitamin D supplements.

Gentle hair care: Avoid harsh treatments like chemical dyes or tight hairstyles. Use gentle shampoos.

If you have alopecia areata, avoid the following:

Harsh hair treatments: Avoid excessive use of chemicals like dyes or heat treatments, as they can further weaken hair follicles.

Stress: Since stress is a known trigger, relaxation techniques like yoga or mindfulness can help reduce flare-ups.

Tight hairstyles: Avoid hairstyles that put tension on the hair, such as ponytails or braids, as they can contribute to hair loss.

Overexposure to the sun: If you’ve lost hair, use hats or sunscreen to protect your scalp from direct sunlight.