Alopecia areata

Hair Loss, Baldness, Balding

What is Alopecia areata?

Alopecia areata is a condition where hair is lost in patches. Hair loss most commonly occurs on the scalp but can also involve facial or body hair. The skin in these bald areas looks and feels normal. Hair loss may suddenly slow or stop and then just as suddenly increase in severity. As many as 60% of the individuals also have accompanying nail changes (such as pitting, ridging, and rough thick nails). Although the cause of alopecia areata is unknown, evidence points to an autoimmune disease, where the body's immune system forms antibodies against itself. Alopecia areata is usually associated with an underlying condition, such as pernicious anemia, Down's syndrome, an underactive thyroid gland, vitiligo (a skin disease with milk-white patches), or an inherited tendency to develop allergies (atopy).

How is it diagnosed?

  • History: Symptoms include hair loss and, sometimes, changes in nails. No scarring is left where the hair used to be. There may be a history of alopecia areata in other family members.
  • Physical exam shows sharply defined patches of hair loss, with no scarring of the underlying skin.
  • Tests: Light hair pull test and skin biopsy may be done. Microscopic analysis may be done to rule out other skin conditions caused by a fungus or tumor. Other tests may be done to rule out systemic disease such as lupus erythematosus, pernicious anemia, or an underactive thyroid.

How is Alopecia areata treated?

Treatment focuses on relieving symptoms since the cause is still unknown. The most common treatment involves injecting the bald patches with corticosteroids. Other approaches, which attempt to stimulate hair regrowth, include systemic and topical steroid therapy, contact allergens, antihypertensives, and psoralens (plant substances that cause inflammation when applied to the skin and exposed to ultraviolet light).

Alopecia areata Medication

Information Brand Generic Label Rating
order Finasteride Propecia Finasteride On-Label

Prograf (Tacrolimus), Flonase (Fluticasone topical), Decadron (Dexamethasone), Medrol (Methylprednisolone)

What might complicate it?

The condition can have disturbing psychological consequences. The unpredictable course of the disease can be confusing and discouraging to the individual.

Predicted outcome

The disease is highly variable, with periods of spontaneous recovery and/or relapse. Individuals with patchy alopecia areata can usually expect regrowth of loss hair. If the individual has a history of atopic dermatitis or asthma, regrowth of loss of hair is less likely.


Other possibilities are male pattern baldness, lichen planopilaris, discoid lupus erythematosus, folliculitis decalvans, fungal infection, and alopecia due to radiation or other skin damage.

Appropriate specialists

Dermatologist and psychiatrist.

Last updated 27 May 2015


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