Home
Bupa members

Support and offers for individual members and customers

Alopecia areata

Published by Bupa's health information team, July 2008.

This factsheet is for people who have alopecia, or who would like information about it.

Alopecia areata causes inflammation of the hair follicles leading to hair loss. The amount of hair lost varies for everyone with the condition. There are a number of treatments available although you may prefer not to use them.

About alopecia areata

Alopecia areata is a chronic, inflammatory condition. A chronic condition is one that lasts a long time, sometimes for the rest of your life. The term chronic refers to time, not to how serious a condition is.

Alopecia areata affects your hair follicles causing patches of baldness. You may find the hair grows back, although this can take months or years. The hair that grows back may be white, at least at first.

Alopecia areata affects everyone differently, but it's likely that you will have more hair loss in the future. However, alopecia areata doesn't cause scarring and your hair follicles won't be permanently damaged. Although you may have hair loss in any one area for a long time, your hair may still be able to grow back.

About one to two people in 1,000 in the UK have alopecia areata. It's thought that up to one in 50 people may be affected but don't go for medical treatment because they only have a mild form. The condition can develop at any age but it's most common in young people aged between 15 and 29 - one in five people with alopecia areata is under 16. It affects men and women equally.

Alopecia areata isn't harmful to your health in any other way.

Symptoms of alopecia areata

Some of the main symptoms of alopecia areata are described here.

  • You will have patchy hair loss. These small, round areas of baldness are most likely to be on your scalp, although they may also occur on your eyebrows, eyelashes and beard.
  • Usually the exposed skin will look smooth and healthy, but occasionally it may be red or scaly.
  • You may have short, broken hairs at the edges of the bald patches. These are called exclamation hairs and are tapered at the end nearest to your head.
  • It's possible that you will have changes to your nails. They may be pitted or split, or have grooves running across them. You may have white patches under the surface.

Complications of alopecia areata

If you have alopecia areata, you may be slightly more at risk of certain autoimmune conditions such as thyroid disease and vitiligo. Autoimmune conditions are caused by your immune system attacking your body.

Sometimes alopecia areata can progress to the loss of all the hair from your scalp (alopecia totalis). It's very rare that you will lose all your body hair (alopecia universalis). The more hair you lose, the less likely it is that the condition will completely go away.

Causes of alopecia areata

The exact reasons why you may develop alopecia areata aren't fully understood at present. However, it's thought to be an autoimmune disease where your body's immune system mistakes your hair follicles for foreign tissue and attacks them. This means they can't produce new hair and existing hair falls out.

About one in four people with alopecia areata have a family member who also has the condition. This suggests that your likelihood of developing alopecia areata is linked to your genes. Genes are bits of code found in every cell in your body that determine characteristics such as your hair and eye colour. You inherit your genes from your parents. It's possible that having a certain combination of genes makes you more likely to develop alopecia areata, although other factors also probably play a part.

If you have another condition that involves your immune system such as eczema or are prone to allergies, you may be more at risk of alopecia areata.

You may be more likely to develop alopecia areata if you are particularly stressed, through bereavement for example, or have been in an accident.

Diagnosis of alopecia areata

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. If there is a possibility that you may have other autoimmune conditions, you may have blood tests or tests to check the level of certain hormones (chemicals that occur naturally in your body).

Treatment of alopecia areata

If you have alopecia areata, there are a number of treatments that you may wish to try, although their effectiveness varies for everyone. There is no evidence to show that any treatment has any long-term benefit.

Some treatments for alopecia areata may encourage your hair to grow back, although none of these can completely cure the condition. Alopecia areata isn't harmful to your physical health and sometimes your hair may grow back without treatment. Therefore, it's important to consider whether the benefits of treatment outweigh any potential disadvantages.

If there is doubt about the diagnosis, or you have questions which your GP can't answer, you may be referred to a dermatologist (a doctor specialising in skin conditions).

Self-help

If you have mild alopecia areata, you may decide not to have any treatment. Your GP may suggest that you wait for up to three months to see whether your hair grows back without treatment.

If you feel uncomfortable about your hair loss, you may wish to wear a hat or a bandanna. Wigs may also be an option. These can be of human or synthetic hair. Ask your GP for more advice about where you can get wigs - he or she may be able to refer you to the relevant department at your local hospital.

Medicines

Corticosteroids

The most common treatment for alopecia areata is with steroid creams, ointments or lotions. You apply a thin layer directly onto your patches of baldness not more than twice a day. You may find the treatment causes itching or hair growth in areas other than where you applied it.

Some studies show that about eight out of 10 people who use corticosteroids for alopecia areata have some regrowth, but about half of these find their hair falls out again when they stop treatment. Other studies have shown a much smaller benefit. Regrowth usually happens within three to six months of starting treatment. If your hair doesn't start to grow back after six months, you will probably be advised to stop using corticosteroids.

If you have more severe alopecia areata, you may be prescribed steroid tablets. These are stronger and you are more likely to have side-effects, including:

  • raised blood pressure
  • weight gain
  • stomach ulcers
  • diabetes
  • osteoporosis

You may be offered corticosteroid injections into the areas of baldness. There is a risk that your skin will become thinner and its colour may change. It's important that you are aware that even if treatment is successful, alopecia areata may still come back.

Ciclosporin

Ciclosporin reduces the effect of particular cells of your immune system. There is some evidence that ciclosporin is effective, but it can cause serious side-effects including kidney damage, liver damage and high blood pressure. If you are taking ciclosporin, you will need to have regular blood tests.

Minoxidil

Minoxidil is used to treat many types of hair loss. Some people find this medicine helps their hair to grow more. You can buy it from a pharmacist without a prescription.

Contact sensitisation

Alopecia areata is thought to be caused by a problem with your immune response. Occasionally it may be possible to trick your immune system into changing the things it reacts to. This is done by applying a chemical to your skin which brings about an allergic reaction in that area. If applied to areas of hair loss, it may cause your hair to start growing again.

Dithranol

This is usually used to treat another skin condition called psoriasis. You can get dithranol as a paste or cream and it's available in different strengths. It irritates your skin and this can sometimes trigger regrowth of your hair. Dithranol can stain your skin and hair a purple/brown colour.

Hospital treatment

You may be offered treatment with ultraviolet light. This will either be ultraviolet B (UVB) radiation or PUVA which uses ultraviolet A (UVA) light and a medicine called psoralen. There isn't much evidence to show that UVB treatment is effective and it can have side-effects such as redness and burning.

If you have treatment with PUVA, you will have psoralen applied to your skin or take it by mouth. Your skin is then exposed to UVA light which activates the psoralen. You will usually need to have this done twice a week for a variable period of time depending on how effective it is. You will need to stay out of the sun and wear photoprotective glasses all day when you have this treatment.

Treatment with UVB light has a number of disadvantages including:

  • an increased risk of skin cancer
  • a high chance of alopecia areata returning when you stop having treatment
  • taking up time

Living with alopecia areata

Although alopecia areata isn't harmful, you may find it upsetting. You may wish to join a support group as many people find it helpful to talk to others with the same condition.

Your hair usually provides some protection from the sun to the skin on your head. If you have alopecia, make sure you use a broad spectrum sunscreen - this means it protects your skin against both UVA and UVB rays. It should have a sun protection factor (SPF) of at least 15. It's also a good idea to wear a hat.

Further information

Sources

  • Alopecia areata. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 9 April 2008
  • Alopecia areata. British Association of Dermatologists. www.bad.org.uk, accessed 9 April 2008
  • Frequently asked questions about alopecia. Alopecia UK. www.alopeciaonline.org.uk, accessed 10 April 2008
  • Delamere FM, Sladden MM, Dobbins HM et al. Interventions for alopecia areata. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No: CD004413
  • MacDonald Hull SP, Wood ML, Hutchinson P et al. Guidelines for the management of alopecia areata. Br Journal Dermatol 2003; 149(4):692-699
  • Joint Formulary Committee, British National Formulary. 54 ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2007
  • Corticosteroids. Alopecia UK. www.alopeciaonline.org.uk, accessed 30 April 2008
  • Systemic corticosteroids. Alopecia UK. www.alopeciaonline.org.uk, accessed 30 April 2008
  • UVB. Alopecia UK. www.alopeciaonline.org.uk, accessed 19 May 2008
  • PUVA. Alopecia UK. www.alopeciaonline.org.uk, accessed 30 April 2008
  • Sunsense: protecting yourself from ultraviolet radiation. Health Protection Agency. www.hpa.org.uk, accessed 30 April 2008
  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd edition. Oxford: Oxford University Press, 2007: 673
  • Ringworm. Medline Plus. www.nlm.nih.gov, accessed 1 May 2008
  • Hair growth and hair loss. British Association of Dermatologists. www.bad.org.uk, accessed 1 May 2008
  • Surgical options: hair transplants - minigrafting, micrografting and follicular units. British Association of Hair Restoration Surgeons. www.hairsurgeons.org.uk, accessed 1 May 2008
  • Hair transplantation: follicular unit transplant method. eMedicine. www.emedicine.com, accessed 1 May 2008

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed Dr Mike Ardern-Jones, BSc, MBBS, MRCP, DPhil, Consultant Dermatologist; Southampton University NHS Trust and Spire Southampton Hospital, and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: July 2008.

 

Rate this page

Feedback

Have you found the information in this factsheet helpful? Do take a couple of moments to give us your feedback.

Click here to give us your feedback

Up to £100 off a Bupa Health assessment

Bupa health insurance

Free online health check

Bupa Care Homes

Bupa travel cover