What is Alopecia Areata?
Alopecia Areata is an autoimmune condition that causes sudden, patchy hair loss on the scalp or other parts of the body.
Who gets alopecia areata?
It can affect people of all ages, including children. It is more common in people with a family history of autoimmune diseases.
What causes alopecia areata?
Stress is a common trigger, but it should be noted that stress affects people in different ways, leading to different medical conditions depending on individual genetics. Alopecia areata is not linked to diet and is not caused by shampoos or other hair products used on the scalp or hair.
When the immune system attacks the hair root, the hair becomes weakened and breaks off, but the root is not destroyed. This means regrowth is always possible.
What are the clinical features of alopecia areata?
- Round or oval patches of hair loss with smooth underlying skin
- Occasional small broken hairs at the edges
- Possible involvement of eyebrows, eyelashes, or beard area
- In severe cases, complete scalp (alopecia totalis) or body hair loss (alopecia universalis)
How is alopecia areata treated?
Treatment aims to stop the immune cells from attacking the hair root. The most effective approach is cortisone (steroid) injections into the skin, as creams usually cannot penetrate deeply enough to reach the follicle. In children, topical treatments are often tried first, as injections can be painful.
- Topical corticosteroids
- Steroid injections
- Oral corticosteroids (for a few weeks only) in extensive or active cases
- Immunotherapy (with DCP – diphenylcyclopropenone)
- Oral immune suppressive therapy (eg. JAK inhibitors such as baricitinib)
What is the outcome of alopecia areata?
The course of alopecia areata is unpredictable. Hair may regrow on its own or with treatment, but relapses are common. Starting treatment early generally offers the best chance of recovery.