What is alopecia?
Alopecia just means hair loss. In the patchy kind, alopecia areata, hair often grows back by itself. But one thing about your hair loss makes a big difference to those odds.
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What is alopecia?
Alopecia is the general word for hair loss. It covers several types, from slow thinning to sudden bald patches.
Alopecia areata is the patchy type. It usually starts as small, round, coin-sized bald patches. Studies suggest as many as 1 in 50 people get it at some point.
Alopecia totalis and alopecia universalis are not separate illnesses. They are alopecia areata at its most widespread.
| Type | What you see | Does hair grow back? |
|---|---|---|
| Alopecia areata | Round, smooth bald patches, often sudden. | Often, over months. New patches can appear. |
| Alopecia totalis | All the hair on your scalp. | Less likely without treatment. |
| Alopecia universalis | All the hair on your scalp, face and body. | Less likely without treatment. |
| Pattern hair loss | Slow thinning that usually runs in the family. | No. The NHS says it is permanent. |
| Traction alopecia | Thin or broken hair where it is pulled tight. | Not usually permanent, if the pulling stops early. |
| Scarring alopecia | Smooth, pale or shiny skin where hair has gone. | Unlikely. Treatment may slow or stop it. |
Sources: BAD; NHS; Alopecia UK; Alopecia UK: scarring
Not sure which type you have? A GP may be able to tell by looking at your hair.
Is a bald spot on my head alopecia areata?
It may be, if the patch appeared quickly and the skin looks normal. The British Association of Dermatologists (BAD) lists these typical signs:
- one or more smooth bald patches that are not red or scaly
- short hairs at the edge that get thinner near the root, called exclamation mark hairs
- itching, burning or tingling before or after the hair falls out
- small dents in your nails, like the dimples on a thimble
A red, scaly or itchy patch is different. Ringworm, a fungal infection, can cause patchy hair loss on the scalp, and usually needs prescription tablets and shampoo.
Most people with alopecia areata need no tests to confirm it. Show your GP the patch while it is still there.
What causes alopecia areata?
Your immune system, which normally fights germs, attacks your hair roots by mistake. That stops them making hair. Why it happens is still not fully understood.
It is not catching, and BAD says it has no connection to food or diet. Stress and past infections are possible triggers, but the link may be coincidence.
About 2 in 10 people with it have a family history. It is also linked to thyroid disease, vitiligo (white patches on the skin), type 1 diabetes, eczema, hay fever and asthma.
Other new symptoms as well? Tell your GP, who may suggest tests. See thyroid antibody tests and blood tests for hair loss.
Will my hair grow back?
Often, yes. The one thing from the top of this page is how much hair you lose at the start.
BAD says that, depending on how much hair is lost, there is a good chance 4 in 5 people regrow fully within a year without treatment. Lose more than half at the start, or all of it at any stage, and the chance of full regrowth is about 1 in 10.
- 20 % or belowMild. Hair may regrow on its own.
- Above 20 to just under 50 %Moderate. Sometimes rated as severe.
- 50 % or aboveSevere. A dermatologist (skin specialist) may offer tablets.
Sources: Alopecia UK; BAD
The odds of regrowth are lower in young children, people with a family history of alopecia areata or other autoimmune conditions (where the immune system attacks the body), hair loss along the back hairline, and nail changes.
New hair usually starts fine and white in the middle of the patch, then thickens and gets its colour back. Most people get further episodes, so keep a dated photo of each patch.
Alopecia areata treatment
There is no cure. Treatment can help hair grow, but none changes the overall course. Mild patches may need no treatment at all.
What is usually offered, by how much hair is lost
- 1
Steroid cream
Steroid cream on the patch for around 6 weeks. It can be repeated.
- 2
Steroid injections
The most effective option for small patches. They may leave a dimple that usually fades.
- 3
Moderate to severe
Steroid tablets may help, but hair can fall out again when you stop.
- 4
Severe, 50% or more
A dermatologist may offer ritlecitinib (age 12 and over) or deuruxolitinib (adults).
Sources: BAD; NICE TA958; NICE TA1178; Alopecia UK
Ritlecitinib and deuruxolitinib are tablets that calm part of the immune system. NICE recommends them for severe alopecia areata. They can raise your risk of infection, so you need checks, such as blood tests, before and during treatment.
With 21% to 49% lost, a dermatologist may rate it as severe if, for example, it badly affects your mood or your eyebrows and lashes.
Minoxidil lotion from a pharmacy has limited evidence on its own. It can sometimes help alongside other treatments. Never stop or change a prescribed medicine without your prescriber.
Six things you can do yourself
- Cover bald patches with sun cream or a hat to stop sunburn.
- Avoid tight ponytails, braids and extensions that pull hard on your hair.
- Take a dated photo of each patch, in the same light, once a month.
- Ask about NHS wigs. They need a specialist’s prescription, and in England you usually pay part of the cost.
- Find a support group on the Alopecia UK website.
- Tell your GP if it is affecting your mood. They may be able to help you get counselling.
For thinning rather than patches, see hair loss treatment for women, hair loss treatment for men and shedding after illness or stress.
When to speak to a GP
The NHS says to see a GP if you’re worried about your hair loss. Book an appointment if:
- You have new bald patches, or patches that are spreading.
- The patch is red, scaly or itchy. Scalp ringworm usually needs prescription tablets and shampoo.
- The skin looks smooth, pale or shiny where hair has gone, or your front hairline and eyebrows are thinning. Scarring hair loss needs a dermatologist promptly.
- You have other new symptoms as well. Your GP may suggest tests.
- Your hair loss is affecting your mood or how you live.
See a GP before paying a commercial hair clinic. Lost half or more of your scalp hair? Ask whether you should see a dermatologist, as GPs are not expected to prescribe the newer tablets.