Alopecia areata

The term alopecia simply means hair loss. There are 3 main types of alopecia areata – patchy, where there is coin-size hair loss on the head and other parts of the body, totalis where there is total scalp hair loss, and universalis where all body hair is lost. The loss of hair is caused by an autoimmune condition where the body attacks its own hair follicles in a process of inflammation. This might cause tingling, burning or itching. Patches are usually coin-sized and look smooth and pinkish. It’s not well understood what prompts this process – stress is one theory, genetics is another as 1 in 5 people with it has a close family member with alopecia.

It can occur at any age and it’s slightly more common in women. Other than the psychological burden and the risk of sunburn, alopecia has no other risk to your health. There is a slightly higher chance of developing other autoimmune conditions, such as vitiligo, lupus, thyroid disease or Type 1 diabetes.

For 4 out of 5 people suffering from alopecia, hair grows back within the first year without treatment. But it’s not guaranteed and the condition can’t be cured: you might get flare-ups in future.

It’s a poorer outlook if there’s extensive hair loss from the start, and the chance of full regrowth is low if you’ve lost more than half of your hair. Occasionally alopecia areata may progress to alopecia totalis (complete hair loss from the scalp) or, more rarely, alopecia universalis (complete hair loss from the scalp and entire body).

In most people the process of inflammation stops and hair regrows, with or without treatment. If your doctor suspects alopecia areata, they may refer you to a dermatologist for a specialist opinion.

The dermatologist will look at your scalp with a dermatoscope (a specialist microscope) and they may take a skin biopsy to confirm the diagnosis. They may suggest treatment like a steroid cream or steroid injections into the bald patches with the aim of dampening down inflammation and encouraging hair growth. They may also suggest other treatments, depending on their assessment, but many carry a risk of unacceptable side effects.

Minoxidil is a treatment available to buy (and not available on the NHS) that serves to prevent hair from shedding. You may choose to try this on any bald patches, but the hair left is often very fine, so this may have limited success. And it only works for as long as you continue using it - it doesn't alter the course of the disease.

Work on your appearance to make you feel more yourself. With patchy loss, you could try out hairstyles or haircuts that disguise bald spots. Wigs are another option, and if you have lost more than half of your hair, you may be eligible for a wig on the NHS. Artificial eyelashes, eyebrow make-up or tattoos to mimic eyebrows or eyeliner can build self-esteem – research what might work for you.

Eyes can get sore without the protection of eyelashes to keep out dust, so wear protective glasses if it’s dusty or sandy, and use eye lubricants or false tears to soothe your eyes. Hair forms a protection against the sun, so bald patches put you at a higher risk of sunburn – wear sunscreen with a broad UVA and UVB protection of SPF 50, and avoid the sun or cover up with a hat where possible. Also be aware of low hanging trees or beams, as you have nothing to protect the scalp from knocks and scrapes.

A much harder task is coming to terms with alopecia and the change in sense of identity and self-esteem that it entails. It can help to be open with trusted family and friends, or see your doctor if you’re feeling very low. Alopecia UK is a charity that can offer support, education and useful resources, so do make contact to see if they can help.