Alopecia areata is an autoimmune condition in which the immune system attacks hair follicles, most often causing smooth, round patches of hair loss. Because it can look like other conditions, can change course quickly and sometimes comes with other health issues, it needs an in-person exam with a dermatologist rather than an online consultation. Below, we explain what alopecia areata is, how it is diagnosed, and why hands-on care matters.
What alopecia areata is
In alopecia areata, immune cells target the base of the hair follicle. The follicle is not destroyed, but it stops producing visible hair for a period of time. This is why alopecia areata is considered a nonscarring form of hair loss: the follicles are still present under the skin.
Alopecia areata can affect people of any age, sex or background, including children. It often appears for the first time in childhood or early adulthood, but it can start at any point in life. It may run in families, and people with alopecia areata are more likely to have other autoimmune conditions, such as thyroid disease or vitiligo, as well as allergic conditions like eczema or asthma.
Common signs
Alopecia areata can look different from person to person. Common features include:
- One or more round or oval patches of hair loss, often on the scalp, beard area or eyebrows
- Patches that are smooth, with skin that usually looks normal and is not scaly or scarred
- Short, broken hairs at the edge of a patch that are narrower at the base, sometimes called "exclamation point" hairs
- Nail changes, such as small pits or ridges
- Occasional tingling, itching or mild discomfort before a patch appears
Some people have one small patch. Others develop several patches that join together. Less commonly, hair loss can involve the entire scalp (alopecia totalis) or the entire body (alopecia universalis). Another pattern, called ophiasis, affects a band of hair along the sides and back of the scalp.
How alopecia areata differs from pattern hair loss
Pattern hair loss, also called androgenetic alopecia, tends to develop gradually. In men it often affects the hairline and crown. In women it often shows up as a widening part or more scalp visible on the top of the head. Hairs become finer over time rather than falling out in a distinct patch.
Alopecia areata usually appears more suddenly and in well-defined patches. The causes, the evaluation and the treatment approach are different. Our article on telogen effluvium versus androgenetic alopecia explains how two other common types of hair loss compare, and our guide to normal versus excessive shedding can help put everyday shedding in context.
Conditions that can look similar
Several other conditions can cause patchy hair loss, which is one reason an exam matters:
- Tinea capitis. A fungal infection of the scalp, more common in children, that can cause scaly patches and broken hairs. It needs prescription antifungal treatment.
- Trichotillomania. Hair pulling that leaves irregular patches with hairs of different lengths.
- Traction alopecia. Loss from long-term tension from tight hairstyles, usually along the hairline.
- Scarring alopecias. A group of conditions in which inflammation destroys follicles, often with redness, scaling, pain or shiny skin. Early diagnosis matters because lost follicles do not come back.
- Secondary syphilis and other systemic illnesses. These can occasionally cause a patchy, "moth-eaten" pattern.
Telling these apart can require a close look with a dermatoscope, lab tests, a fungal culture or a scalp biopsy, all of which happen in person.
How it is diagnosed
A dermatologist usually diagnoses alopecia areata from the history and a careful exam of the scalp, hair and nails. During the visit, they may:
- Examine the patches with a dermatoscope to look for characteristic signs
- Do a gentle pull test at the edges of a patch
- Check the eyebrows, eyelashes, beard and body hair
- Order blood tests to look for related conditions, such as thyroid disease
- Take a small scalp biopsy if the diagnosis is not clear
If you are unsure whether to start with a dermatologist or another specialist, our article on trichologists and dermatologists explains the difference.
How alopecia areata is managed
The course of alopecia areata is hard to predict. In some people, hair returns without treatment. In others, patches come and go, or the condition becomes more extensive. Because of this, treatment decisions are individual and are made with a dermatologist who can examine the scalp and follow changes over time.
Options a dermatologist may discuss include:
- Corticosteroids injected into patches, applied to the skin, or in some cases taken by mouth for short periods
- Topical immunotherapy, which uses a substance applied to the scalp to change the local immune response
- JAK inhibitors, a newer class of oral medications, some of which are FDA-approved for severe alopecia areata in certain age groups. These require screening and monitoring with lab tests.
- Other medications used off-label based on the individual situation
- Cosmetic and supportive options, such as hairpieces, brow products or support groups
Several of these options involve procedures, lab monitoring or medications with serious side effects that call for regular in-person follow-up. That is part of why alopecia areata is outside the scope of an online hair loss consultation. A licensed provider decides whether treatment is appropriate for each person.
When to see someone in person
Book an in-person visit with a dermatologist or your primary care provider if you notice:
- Sudden, round or oval patches of hair loss on the scalp, beard, eyebrows or elsewhere
- Patches that are spreading or joining together
- Loss of eyebrows or eyelashes
- Scaling, redness, pain, burning, pus or shiny skin in an area of hair loss
- Hair loss in a child
- Hair loss along with fatigue, weight changes or other new symptoms
Seek care promptly if a patch is painful, inflamed or growing quickly, since some conditions that look similar can cause permanent loss if not treated early.
The emotional side
Alopecia areata can be stressful, particularly because it often appears without warning and its course is uncertain. Feelings of worry, frustration or self-consciousness are common and valid. A dermatologist can talk through medical and cosmetic options, and patient organizations offer education and peer support. If the emotional impact is affecting daily life, it is worth mentioning to a primary care provider or a mental health professional.
The bottom line
Alopecia areata is an autoimmune condition that usually causes smooth, patchy hair loss. Because it can resemble other conditions and its treatment often involves procedures and monitoring, the right first step is an in-person visit with a dermatologist.
Prescribed Essence focuses on gradual, pattern-type hair changes. Patchy or sudden hair loss is outside the scope of our online service and calls for in-person care. For pattern-type hair loss, if a compounded formula is prescribed, it is prepared by a licensed pharmacy for that individual patient. Compounded medications are not FDA-approved. If the changes you are noticing are gradual and you would like a licensed provider to review your history and photos, you can start your online consultation.
Prescription required. A licensed provider decides whether treatment is appropriate. Compounded medications are prepared by a licensed pharmacy for an individual patient and are not FDA-approved. Individual results vary. Prescribed Essence currently serves patients in California, Colorado, Florida and New York.
