Alopecia advice: Alopecia Areata
All information is taken from the Alopecia UK website (with permission). For more help and advice on alopecia, visit the Alopecia UK.
What is alopecia areata?
Alopecia areata is an autoimmune condition that causes sudden, patchy hair loss on the scalp, beard, eyebrows, eyelashes, or other parts of the body. It affects people of all ages and backgrounds and can vary in severity from small round patches to complete hair loss across the scalp and body.
What causes alopecia areata?
In alopecia areata, certain immune cells (known as CD8+ NKG2D+ T cells) mistakenly attack the hair follicles, stopping them from producing new hair. The exact reason why this happens is not fully understood. Both environmental factors (influences from outside the body) and genetics are believed to play a role in causing the condition.
Types of alopecia areata
Patchy alopecia areata
The most common type, appearing as one or more coin-sized patches of hair loss on the scalp or other areas. Many people experience spontaneous regrowth, but some develop persistent or chronic patchy alopecia.
Alopecia totalis
A more severe form of alopecia areata, also known as AT, which involves complete loss of scalp hair. It may start with patches or occur suddenly.
Alopecia universalis
The most extensive form of alopecia areata, also known as AU, which involves total loss of hair on the scalp, face, and body.
Please note, many people experience forms of alopecia areata that are somewhere between alopecia totalis and alopecia universalis, losing some but not all body hair, or some but not all facial hair.
Diffuse alopecia areata
In this form, hair thinning is evenly spread across the scalp rather than in distinct patches. It can look like other types of hair loss, such as Telogen Effluvium or Pattern Hair Loss.
Alopecia areata ophiasis
This pattern affects the hairline at front, sides and back of the scalp and can be more difficult to treat.
Alopecia barbae
This form affects the beard and moustache area, often appearing as small circular patches that can merge. Hair at the edges of these patches may turn white.
Does it affect anything other than hair?
Yes. Up to 50% of people with alopecia areata also experience nail changes, such as pitting, ridging, or roughness.
As well as inflammation attacking hair follicles in the skin, there is evidence of inflammatory changes in the blood of people with AA. The presence of this inflammation may link alopecia areata to other disorders such as depression and cardiovascular disease.
Alopecia areata symptoms
Common symptoms of alopecia areata include:
- Sudden, patchy hair loss
- Patches that may expand or merge
- Thinning or total hair loss in severe cases
- Itching, tingling, or burning of the scalp (less common)
Who is at risk?
Alopecia areata is considered a polygenic condition. This means that a number of genes, combined with environmental triggers, contribute to its development. Those at higher risk of developing alopecia areata include:
- People with a family history of alopecia areata
- Those with atopic conditions (eczema, asthma, or hay fever)
- Individuals with certain genetic or chromosomal disorders such as Down’s syndrome
How many people have alopecia areata?
Alopecia areata affects approximately 1 in every 1,000 people worldwide at any given time. It can happen in men, women, and children of all ages and ethnic backgrounds. Studies suggest that as many as 1 in 50 people will experience the condition at some point in their lives. A study in the UK found that people of Asian, Black and Mixed ethnic groups were at higher risk of developing the condition compared to those of White ethnicity.
How is alopecia areata diagnosed?
Alopecia areata can be diagnosed by a General Practitioner (GP) or dermatologist. In some cases, further testing may be needed to confirm the diagnosis. A doctor may want to use a tool to look at the scalp up close (trichoscopy). Or, they may want to take a small piece of skin (skin biopsy) to be analysed in a laboratory.
How long does it last?
Alopecia areata is a non-scarring form of hair loss, that does not permanently damage hair follicles. The hair follicles are still capable of growing new hair, although something prevents them from doing so. Many people experience regrowth within months or years, although further loss is common. In cases where the condition progresses to total scalp or body hair loss, the chances of full regrowth are smaller but still a possibility.
Treatment options for alopecia areata
There is currently no cure for alopecia areata, but several treatments can help encourage regrowth. Treatment options may include:
- Topical, injected, or oral corticosteroids
- Topical immunotherapy
- Oral immunosuppressants
- JAK inhibitors (for severe cases only. Ritlecitinib is currently the only NICE-recommended treatment for severe alopecia areata – find out more about it here.)
- Minoxidil is sometimes used as an adjuvant treatment, meaning it is used in combination with another treatment to support regrowth.
Many people, especially those with mild symptoms, experience spontaneous regrowth without receiving medication.
Is alopecia areata inherited?
About 20% of people with alopecia areata (1 in 5) have a history of the condition in another family member. While there is a slightly increased risk of alopecia areata happening in a child of someone who has the condition, the chance is about 5-6%, compared to a 2% risk in the general population.
Additional Resources:
The British Association of Dermatologists (BAD) has produced a Patient Information Leaflet for alopecia areata.
READ THE BAD PATIENT INFORMATION LEAFLET ON ALOPECIA AREATA
BAD also have a living guideline for managing people with alopecia areata. The overall objective of the living guideline is to provide up-to-date, evidence-based recommendations for the management of alopecia areata. This can help guide patients to understand what treatments to discuss with their dermatologist. The guideline itself could be a topic to speak with your dermatologist about to ensure they are following the latest guidance.
DISCOVER THE BAD LIVING GUIDELINE FOR MANAGING PEOPLE WITH ALOPECIA AREATA
The British Hair and Nail Society (BHNS) also have some useful information on alopecia areata.
The Onballa UK app is designed to help those living with alopecia areata. The free app includes the following features:
- Hair Gallery: track your hair loss or regrowth over time
- Mood Tracker: track any trends in your mood
- Analysis Reports: generate personalised reports to support conversations with your doctor
- Videos and resources: learn more about alopecia areata
- Well-being exercises: access a library of wellness tips and exercises
- Support: find support and advocates from the alopecia community
