Alopecia areata

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 8, 2016
StartDiseasesAlopecia areata

Affecting more than 6.6 million Americans and 147 million people worldwide according to the National Alopecia Areata Foundation, alopecia areata is an autoimmune disorder that causes areas of hairlessness on the body. Alopecia areata usually presents as a small, circular, hairless patch on the scalp but can start wherever there are hair follicles on the body. Alopecia areata causes the body's immune system to view the hair follicles as invaders and therefore begins to attack them.


Definition & Facts

Alopecia can present in three ways:

  • Alopecia areata: the most common form of the disorder that results in circular patches of hairless skin in varying sizes.
  • Alopecia totalis: results in complete baldness of the scalp.
  • Alopecia universalis: the least common of the three disorders and results in loss of hair over the entire body.

The condition occurs in less than 1 percent of the population and can affect both females and males. Teenagers are most commonly afflicted but the disease can occur at any age, including early childhood and late in life. An unpredictable disorder, alopecia can cause permanent hair loss though sometimes hair regrows on its own. Alopecia areata cannot be cured although it can be treated, and treatment success varies.

Symptoms & Complaints

Alopecia areata will begin as one or more small, hairless patches, usually on the scalp. Those who are affected with alopecia areata may experience itching on the affected areas and nail stippling in their fingernails and toenail. Feelings of anxiety are also common among those afflicted with this disease.


The etiology of autoimmune disorders is not fully understood; it is a random, systemic immune disorder. It is not contagious. Individuals who have other autoimmune disorders, such as hypothyroidism, diabetes mellitus, and asthma are more likely to develop alopecia areata than are those who have no other autoimmune disorders. A family history of alopecia areata may increase the likelihood of developing it.

Some research indicates that environmental factors may also play a part in triggering an onset of alopecia areata. These could include exposure to viruses and bacteria. Those who have experienced high stress levels seem to be more susceptible to developing autoimmune disorders, including alopecia areata.

Diagnosis & Tests

Even though lab tests and images are not absolutely required, a blood test will reveal the following levels, which are necessary for an accurate diagnosis of alopecia areata:

In order to positively identify that the hair loss is due to alopecia areata and eliminate other factors, analysis of the above levels is necessary. Hair loss can occur as a result of many factors; blood testing will rule them out and establish the diagnosis of alopecia areata.

Treatment & Therapy

Currently, there are no medications available that are designed specifically for alopecia areata. However, topical immunotherapy has seen some success in stimulating hair regrowth. This treatment causes inflammation in the skin, which stimulates the follicles and may cause hair regrowth. Corticosteroids have also been used for treatment of alopecia areata but users may see only a gradual response to this treatment. Application may be topical, such as lotion, cream, or foam, or it may be in pill form.

Topical minoxidil has also been used with varying success rates. Since this disorder is unique to each person, the treatment regimen must be tailored specifically to the individual and the results will be unique to each individual. Regrowth is possible and alopecia areata can present, subside, and then recur. The affected hair follicles shrink but remain alive; regrowth can occur without treatment.

In addition, sunscreens are essential to those who lack hair, whether on the head, the face, or the entire body. Protective headgear in the form of caps, scarves, or even hair pieces will help protect from painful and unhealthy sunburns. Those who lack nasal hair should apply a soothing ointment to the inside of the nostrils, both to keep the nasal membranes lubricated and to help filter out invading substances that would normally be filtered by the nasal hair. Protective eye wear is essential for those who have lost eyebrows, and eyelashes.

Prevention & Prophylaxis

Since the exact cause of alopecia areata is unknown, it's difficult to delineate the factors that will encourage or prevent development of the disease. However, maintaining a healthy lifestyle and keeping stress levels to a minimum can be helpful preventions.

An adequate intake of biotin may help prevent the onset of alopecia areata. Biotin isn't stored in the body but can be obtained from eggs, nuts, sardines, and brewer's yeast. Adults should receive approximately 30 mcg of biotin each day.

Adequate amounts of zinc, thiamine, and vitamin C are also thought to be factors in deterring the development of alopecia areata, particularly for those who already have one or more additional autoimmune disorders.