Condition Basics

What is alopecia areata?

Alopecia areata (say "al-uh-PEE-shuh ar-ee-ah-tuh") is a type of hair loss that affects hair on the scalp or other areas of the body. The condition happens when your immune system mistakenly attacks hair follicles, where hair growth begins. Alopecia areata is more common in young people. But it can happen at any age.

What are the symptoms?

Alopecia areata usually begins when clumps of hair fall out. You then may have smooth, round hairless patches on the scalp or other areas of the body, like the eyebrows. Sometimes the hair may become thinner without patches of baldness. Or it may grow and break off, leaving short stubs (called "exclamation point" hairs). The hair loss often comes and goes—hair will grow back over several months in one area but will fall out in another area.

When there are patches of hair loss, the hair often grows back within one year. Though the new hair is usually the same color and texture as the rest of the hair, it sometimes is fine and white.

Sometimes the fingernails and toenails look as if a pin had made many tiny dents in them. They may also look like sandpaper.

How is it diagnosed?

Alopecia areata is diagnosed through a medical history and physical exam. Your doctor will ask you questions about your hair loss, look at the pattern of your hair loss, and check your scalp. And the doctor may tug gently on a few hairs or pull some out.

If the reason for your hair loss is not clear, your doctor may do tests to check for a disease that could be causing your hair loss. Tests may include:

• Hair analysis. Your doctor will take a sample of your hair and look at it with a small hand-held microscope called a dermatoscope. A scalp biopsy is also sometimes taken.
• Blood tests. This includes testing for a specific condition, such as a thyroid problem. This condition is often linked to thyroid issues.

How is alopecia areata treated?

Because hair usually grows back within a year, you may decide not to treat alopecia areata with medicines.

For older children and adults with patchy hair loss, the most common treatment is shots of medicine into the bald spots. The shots are given every 4 to 8 weeks as needed. Children and some adults may be treated by applying the medicine to the bald spots. Minoxidil (Rogaine) may also be used. Other products may be applied to the skin for a short time and then washed off.

For more severe hair loss, topical immunotherapy may be used. It triggers an allergic reaction on the scalp that may help hair to grow. The medicine is "painted" on the scalp once a week. This irritates the skin and makes it red and scaly. Hair growth may appear within 3 months of starting treatment. If needed, other medicines that work on the immune system may be used.