Everyone’s alopecia areata is different. Even though everyone who has it experiences hair loss, it may have many variations, including where, when, and how often you lose your hair.
Alopecia areata is an unpredictable autoimmune skin disease. Your immune system attacks your healthy hair follicles, which leads to hair loss.
Here’s what you can expect and what may be unique for you.
Where You Lose Hair
With alopecia areata, you may lose hair on your scalp, face, or other parts of your body.
There are three main types of alopecia areata. They include patchy alopecia areata, alopecia totalis, and alopecia universalis.
With patchy alopecia areata, you may have patches of hair loss that are the size of a quarter, oval-shaped, and flesh-colored. You may have bare patches on any part of your body.
With alopecia totalis, you lose hair on your entire scalp. It may start as patchy alopecia areata, then develop into alopecia totalis about 6 months later.
If you have alopecia universalis, you have hair loss on your whole body. You may lose hair on your arms, back, chest, eyebrows, eyelashes, legs, pubic area, and underarms. Alopecia universalis is rare.
Most people with alopecia areata have hair loss on their head and face. You may have it in just one spot, like your beard area or just one side of your scalp. It may also affect your eyebrows, eyelashes, and nose hairs.
How Severe It Is
Your hair loss may be mild or severe. It may be progressive, meaning it gets worse over time, or it may not.
For some people, small bare patches join together and turn into large patches.
You’re more likely to have extensive alopecia areata if:
- You have eczema.
- You’ve had alopecia for a long time.
- You developed alopecia areata at a young age.
- You have a lot of hair loss or complete hair loss on your scalp or body.
How It Feels and Looks
Bare patches are often smooth, round, and peach-colored. For most people, there’s no rash, redness, or scarring. But you may feel a sensation before your hair falls out, like burning, itching, or tingling.
Some people notice the hairs around the patches are short and broken. They may have the shape of an exclamation point, with a narrow base and thin tip.
You may notice changes in your fingernails and toenails. They may feel rough. You may see ridges, pits, white spots, or white lines. This is more common if you have extensive hair loss.
When It Starts
You can develop alopecia areata at any age. Some people develop it during childhood. It’s common to happen for the first time in your teens, 20s, or 30s.
Why You Have It
Doctors aren’t sure what causes alopecia areata, but they think it’s linked to certain genes and environmental triggers. It may run in your family, or it may not. Everyone’s different.
What triggers your alopecia areata may be different from what triggers someone else’s. Common triggers include major life events, trauma, other illnesses, and stress. But you may not have any obvious trigger.
How Often It Happens
You may have temporary hair loss that happens just once. Your hair may grow back in a few months, even if you don’t get treatment. You may have bouts of hair loss here and there or you may have it your whole life.
You may suddenly lose a lot of hair or it may happen gradually.
If Your Hair Grows Back
With alopecia areata, your hair follicles are still alive, so it’s possible your hair may grow back.
If it grows back, you may not experience hair loss anymore. Or it may fall out again later.
It’s possible your hair will grow back in one spot but fall out in another. New bare patches may develop at any time.
If your hair grows back, it may happen within a few months. For some people, the color of newly regrown hair is a little different. It may start out white or gray, then get back to its usual color.
It’s hard to predict, but your chances of it growing back may be better if:
- Your alopecia areata is mild.
- You developed it later in life.
- You don’t have any nail problems.
- You don’t have a family history of alopecia areata or other autoimmune diseases.
If you lose all your hair and it isn’t growing back, it doesn’t mean it won’t ever grow back. For some people with alopecia areata, it does. It’s hard to predict.
Which Treatments Work for You
If your hair loss is mild, or less than 50%, you’re more likely to find an effective treatment that stops your immune system from attacking your hair follicles and stimulates new hair growth.
Treatments may include:
- Oral medications
- Phototherapy or light treatments
- Topical medications
Your dermatologist will help you find the best treatment. It may depend on what type of alopecia areata you have, how mild or severe it is, and how old you are.
There’s no treatment that works for everyone. You may need to try a variety of treatments before you find one that helps.
Photo Credit: SCIENCE PHOTO LIBRARY / Science Source
American Family Physician: “Hair Loss: Common Causes and Treatments.”
American Academy of Dermatology Association: “Hair Loss Types: Alopecia Areata Self-Care.”
American Academy of Family Physicians: “Alopecia Areata.”
Cleveland Clinic: “Alopecia Areata.”
Mayo Clinic: “Hair Loss.”
National Alopecia Areata Foundation: “Treatments for Alopecia Areata,” “What You Need to Know About the Different Types of Alopecia Areata.”
National Institutes of Health: “Alopecia Areata.”
University of Florida Health: “Alopecia Areata.”