Alopecia areata

The term alopecia simply means hair loss. There are 3 main types of alopecia areata – patchy, where there is coin-size hair loss on the head and other parts of the body, totalis where there is total scalp hair loss, and universalis where all body hair is lost. The loss of hair is caused by an autoimmune condition where the body attacks its own hair follicles in a process of inflammation. This might cause tingling, burning or itching. Patches are usually coin-sized and look smooth and pinkish. It’s not well understood what prompts this process – stress is one theory, genetics is another as 1 in 5 people with it has a close family member with alopecia.

It can occur at any age and it’s slightly more common in women. Other than the psychological burden and the risk of sunburn, alopecia has no other risk to your health. There is a slightly higher chance of developing other autoimmune conditions, such as vitiligo, lupus, thyroid disease or Type 1 diabetes.

For many people suffering from alopecia, hair grows back within the first year without treatment. But it’s not guaranteed, and the condition can’t be cured: you might get flare-ups in the future.

It’s a poorer outlook if there’s extensive hair loss from the start, and the chance of full regrowth is low if you have lost more than half of your hair. Occasionally alopecia areata may progress to alopecia totalis (complete hair loss from the scalp) or, more rarely, alopecia universalis (complete hair loss from the scalp and entire body).

In most, the process of inflammation stops, and hair regrows, with or without treatment. If your doctor suspects alopecia areata, they may refer you to a dermatologist for a specialist opinion.

The dermatologist will look at your scalp with a dermatoscope (a specialist microscope) and they may take a skin biopsy to confirm. They may suggest treatment like a steroid cream or steroid injections into bald patches. This is with the hope of reducing inflammation and encouraging hair growth.

Depending on their assessment, they may suggest other treatments, but many risk unacceptable side effects.

Minoxidil is a treatment available to buy over-the-counter that serves to prevent hair from shedding. You may choose to try this on any bald patches, but the hair left is often very fine, so this may have limited success. And it only works for as long as you continue using it; it doesn't alter the course of the disease.

Work on your appearance to make you feel more like yourself. With patchy loss, you could try out hairstyles or cuts that disguise bald spots. Wigs are another option. Artificial eyelashes, eyebrow makeup, or tattoos to mimic eyebrows or eyeliner can build self-esteem – research what might work for you.

Eyes can get sore without the protection of eyelashes to keep out dust, so wear protective glasses if it’s dusty or sandy, and use eye lubricants or artificial tears to soothe the eyes. Hair forms a protection against the sun, so bald patches put you at a higher risk of sunburn – wear sunscreen with broad UVA and UVB protection of SPF 30 or higher, and avoid the sun or cover up with a hat where possible. Also, be aware of low-hanging trees or beams, as you have nothing to protect the scalp from knocks and scrapes.

A much harder task is coming to terms with alopecia and the change in sense of identity and self-esteem that it entails. It can help to be open with trusted family and friends or see your doctor if you’re feeling very low.