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Alopecia areata: Diagnosis and treatments

What is alopecia areata?

Alopecia areata refers to a specific condition that causes small patches of hair loss. ‘Alopecia’ is the term for any type of hair loss, and ‘areata’ means an area or patch. The patches of hair loss are smooth and shiny, and the skin is not scarred, inflamed or scaly. The patches tend to appear quickly and are about the size of a coin.


What are alopecia totalis and alopecia universalis?

Alopecia totalis is the name for when alopecia areata causes the loss of all the hair on the scalp, alopecia universalis is the total loss of all hair on the scalp and body, including eyebrows and eyelashes. About 20% of people with alopecia develop totalis or universalis. In alopecia universalis, you may not lose all of your body hair, for example you may retain hair in some areas.


How is alopecia areata diagnosed?

Alopecia areata can be diagnosed by visiting your GP, a trichologist or a dermatologist. When you go to your appointment, the area of hair loss will be examined and your patient history will be discussed. You may need a biopsy to confirm the diagnosis.


What causes alopecia areata?

Alopecia areata is an autoimmune condition, where the body attacks the hair follicles causing inflammation and hair loss. No one knows what triggers autoimmune conditions, but commonly theorised risk factors are:


  • Having or developing other autoimmune conditions such as vitiligo, lupus, thyroid problems, diabetes, psoriasis and rheumatoid arthritis

  • Having a family member with alopecia areata

  • Environmental irritants

  • High stress levels

  • Nutritional deficiencies

  • Infections

  • Reactions to medications

It’s important to emphasise that autoimmune conditions are complex and there is no conclusive evidence that any of the above factors cause alopecia areata.


Is alopecia areata inherited?

Yes, alopecia areata may be inherited. Research has shown that around 1 in 5 people with alopecia areata have other family members who also have the condition. People with a family history can have more widespread hair loss as well as less chance of the hair regrowing.


Does alopecia areata have any symptoms?

Many people with alopecia areata report a tingling, burning or itching sensation in the area of scalp before and during experiencing hair loss. This tingling sensation may be a result of the inflammation in the hair follicles. There may also be changes to the nails, for example small dents or ridges.


What are the treatments for alopecia areata?

For many people with alopecia areata, no treatment is necessarily required as the hair will often grow back spontaneously. More severe cases can benefit from treatment although the progression of the hair loss is difficult to predict. Whether or not you have treatment is up to you, some people find it reassuring to have treatment, but others prefer not to.


The treatments for alopecia areata are:


  • Steroid creams, steroid tables and steroid injections – These are prescribed by a GP or dermatologist and tend to be used for a short period of time.

  • Dithranol cream – This cream is used to irritate the skin and it can sometimes appear to stimulate hair regrowth.

  • UV treatment – This can be UV treatment with a trichologist, or PUVA treatment which is UV treatment combined with a drug called psoralen which makes the skin sensitive to UVA.

  • Minoxidil – This is a standard treatment for other types of hair loss, minoxidil works by widening the blood vessels on the scalp and may help regrow some hair although it tends to be finer.

  • Immunosuppressive treatments – Various drugs that suppress the immune system can be prescribed in severe cases of alopecia areata, however there are potentially severe side effects.

  • Contact sensitisation treatment – This treatment involves triggering a mild allergic response in the area of hair loss which can sometimes trigger the hair to grow.

  • Hair systems – There are many options to camouflage hair loss caused by alopecia areata, for example hair extensions, hair systems, and wigs.

  • Scalp micropigmentation – Scalp micropigmentation for alopecia areata can be a good option for people who prefer not to wear wigs or hair systems. Scalp micropigmentation is a type of semi-permanent tattooing that can give the appearance of denser hair.

  • Diet and lifestyle – No one knows what causes autoimmune conditions, but there is research to suggest that stress and nutrient deficiencies, particularly a deficiency in Vitamin D, can effect your immune system.

UV treatment is available at the Kate Holden Clinic, if you require steroids or other medical treatment, Kate will refer you to your GP or a dermatologist.


What age does alopecia areata start?

Alopecia areata can start at any age, but the majority of people will experience their first episode before the age of 30. If you have alopecia areata as a child, it is less likely that your alopecia areata will be mild.


Is there a cure for alopecia areata?

There is no cure for alopecia areata, but for 80% of people their hair will recover within the first year of experiencing hair loss. If your hair does regrow, there is a chance that you may have further episodes of hair loss in the future. If you have more widespread hair loss, there is less chance that your hair will recover, but 1 in 10 people with severe loss do have a full recovery.


Is it normal to be upset about alopecia areata?

Yes, all types of hair loss can be very difficult to deal with, and as alopecia areata is unpredictable many people find the uncertainty worrying. Support when going through hair loss is important, be it from a professional, a support group or your friends and family. If you are upset about your hair loss, please speak to someone.


Famous celebrities with alopecia areata

If you or someone you know might have alopecia areata, you're not alone. As hair loss is becoming less taboo, some celebrities have opened up about their diagnosis, including:


  1. Gail Porter (TV presenter)

  2. Matt Lucas (actor)

  3. Jesy Nelson (singer)

  4. Viola Davis (actor)

  5. Jemima Goldsmith (journalist and activist)

What should I do if I think I have alopecia areata?

If you’re worried about areas of hair loss in your own scalp or a family member’s, please speak to a GP, trichologist or dermatologist as soon as possible.


Click here to book a consultation appointment with the Kate Holden Clinic for professional examination, diagnosis, and treatment plans.


Visit the Kate Holden Clinic hair loss treatment centre in Manchester to see a registered trichologist.

Remedy Lounge, Deansgate, Manchester M3 4BQ

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