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Alopecia areata

Alopecia totalis; Alopecia universalis; Ophiasis; Hair loss - patchy

Alopecia areata is a condition that causes round patches of hair loss. It can lead to total hair loss.

Causes

Alopecia areata is thought to be an autoimmune condition. This occurs when the immune system mistakenly attacks and destroys healthy hair follicles.

Some people with this condition have a family history of alopecia. Alopecia areata is seen in men, women, and children. In a few people, hair loss may occur after a major life event such as an illness, pregnancy, or trauma.

Symptoms

Hair loss is usually the only symptom. A few people may also feel a burning sensation or itching.

Alopecia areata usually begins as one to several (1 cm to 4 cm) patches of hair loss. Hair loss is most often seen on the scalp. It may also occur in the beard, eyebrows, pubic hair, and arms or legs in some people. Nail pitting may also occur.

Patches where hair has fallen out are smooth and round in shape. They may be peach-colored. Hairs that look like exclamation points are sometimes seen at the edges of a bald patch.

If alopecia areata leads to total hair loss, it often occurs within 6 months after symptoms first start.

Exams and Tests

The health care provider will examine you and ask about your symptoms, focusing on areas where you have hair loss.

A scalp biopsy may be done. Blood tests may also be done to check for autoimmune conditions and thyroid problems.

Treatment

If hair loss is not widespread, the hair will often regrow in a few months without treatment.

For more severe hair loss, it is not clear how much treatment can help change the course of the condition.

Common treatments may include:

  • Steroid injection under the skin surface
  • Medicines applied to the skin
  • Ultraviolet light therapy

A wig may be used to hide areas of hair loss.

Support Groups

The following groups can provide more information on alopecia areata:

Outlook (Prognosis)

Full recovery of hair is common.

However, some people may have a poorer outcome, including those with:

  • Alopecia areata that starts at a young age
  • Eczema
  • Long-term alopecia
  • Widespread or complete loss of scalp or body hair

When to Contact a Medical Professional

Call your provider if you are concerned about hair loss.

References

Gawkrodger DJ, Ardern-Jones MR. Disorders of hair. In: Gawkrodger DJ, Ardern-Jones MR, eds. Dermatology: An Illustrated Colour Text. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 35.

Habif TP. Hair diseases. In: Habif TP, ed. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 24.

    • Alopecia areata with pustules

      Alopecia areata with pustules - illustration

      Pus-filled lesions (pustules) are unusual in alopecia areata, but can occur, as in this picture. The pustules are infected where medication was injected into the area.

      Alopecia areata with pustules

      illustration

    • Alopecia totalis - back view of the head

      Alopecia totalis - back view of the head - illustration

      Hair loss is referred to as alopecia. Patchy hair loss on the scalp is called alopecia areata. Complete scalp hair loss is alopecia totalis. Loss of all body hair is called alopecia universalis.

      Alopecia totalis - back view of the head

      illustration

    • Alopecia totalis - front view of the head

      Alopecia totalis - front view of the head - illustration

      Hair loss is referred to as alopecia. Patchy hair loss on the scalp is called alopecia areata. Complete scalp hair loss is alopecia totalis. Hair loss from the entire body, including the eyebrows, eyelashes, and body hair, is alopecia universalis.

      Alopecia totalis - front view of the head

      illustration

    • Alopecia, under treatment

      Alopecia, under treatment - illustration

      This picture shows alopecia areata, under treatment. The hair loss is being treated with anthralin, which causes the brownish hyperpigmentation and can induce hair regrowth. It is very unlikely regrowth will occur when hair is lost along the scalp margin (ophiasis).

      Alopecia, under treatment

      illustration

      • Alopecia areata with pustules

        Alopecia areata with pustules - illustration

        Pus-filled lesions (pustules) are unusual in alopecia areata, but can occur, as in this picture. The pustules are infected where medication was injected into the area.

        Alopecia areata with pustules

        illustration

      • Alopecia totalis - back view of the head

        Alopecia totalis - back view of the head - illustration

        Hair loss is referred to as alopecia. Patchy hair loss on the scalp is called alopecia areata. Complete scalp hair loss is alopecia totalis. Loss of all body hair is called alopecia universalis.

        Alopecia totalis - back view of the head

        illustration

      • Alopecia totalis - front view of the head

        Alopecia totalis - front view of the head - illustration

        Hair loss is referred to as alopecia. Patchy hair loss on the scalp is called alopecia areata. Complete scalp hair loss is alopecia totalis. Hair loss from the entire body, including the eyebrows, eyelashes, and body hair, is alopecia universalis.

        Alopecia totalis - front view of the head

        illustration

      • Alopecia, under treatment

        Alopecia, under treatment - illustration

        This picture shows alopecia areata, under treatment. The hair loss is being treated with anthralin, which causes the brownish hyperpigmentation and can induce hair regrowth. It is very unlikely regrowth will occur when hair is lost along the scalp margin (ophiasis).

        Alopecia, under treatment

        illustration

      Review Date: 10/14/2018

      Reviewed By: Michael Lehrer, MD, Clinical Associate Professor, Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

      The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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