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All About: Alopecia Areata

  • Writer: Leilani W
    Leilani W
  • Sep 19, 2025
  • 7 min read

For today’s topic, we’ll be looking at alopecia, but more specifically, alopecia areata. September is Alopecia Areata Awareness Month, and like my psoriasis post in August, I thought it would be fitting to research and write about it. I think this is going to be a trend going forward!



Alopecia vs Alopecia Areata

Alopecia, to put it simply, is hair loss. Unlike many of us who shed a lot of hair daily, alopecia is characterized by excessive hair falling, followed by no regrowth. This leads to bald spots. It doesn’t just affect your scalp, but it can also cause hair loss on the rest of your body. It can be temporary or permanent, and it is not contagious.


Alopecia areata is a subtype of alopecia. If we break the words apart, we get "Alopecia," which is the medical term for hair loss, and "areata," meaning "random areas." Around 2% of the world's population experienced it, with 7 million being in the US. It is characterized by hair falling out in random oval/round patches (about the size of a quarter). This happens very unpredictably and can occur over and over, even regrowing after many years of experiencing hair loss.


There are several different types of alopecia, but for the purposes of this entry, we'll focus on two categories that alopecia types can fall under: Nonscarring and cicatrical (scarring) alopecia. Alopecia areata is part of the nonscarring category.


Some symptoms seen in alopecia areata include:

  • sudden hair loss on the head/scalp or throughout the body, such as the face or genital area

  • bald patches can overlap in circular shapes and leave short, broken hairs at the edges

  • Nail pitting (tiny dents or depressions in the surface of the nails)

In some rare, severe cases:

  • Pruritus (medical word for itchiness)

  • change of color in the hair loss patches (due to inflammation or pigmentation changes)

  • the follicular ostia / hair follicles (tiny openings where hair grows out of your skin) become more visible

  • "exclamation point hairs" (hairs that are thicker on the top and narrow toward your scalp)

  • "cadaver hairs" (when hairs break off right at the surface of the scalp, leading to black dots inside the follicle openings; they look like lifeless, dead stubs)

  • growth of white hairs



Types of Alopecia Areata

There are 3 main types of alopecia, which are based on the total amount of hair loss:

  • Patchy Alopecia Areata:

The most common type. Has the earlier mentioned characteristics of one or more coin-sized, round patches on the scalp or other parts of the body. It can eventually convert to totalis alopecia or universalis alopecia.

Patchy Alopecia Areata example. Scalp with round, bald patches.

  • Totalis Alopecia Areata:

Characterized by complete hair loss on your scalp (so basically complete/total baldness).

Totalis Alopecia Areata example. Scalp with no hair, complete baldness.

  • Universalis Alopecia Areata:

Similar to totalis alopecia areata, where all hair on the scalp is lost, but it also includes the rest of your body, like your eyebrows and eyelashes ('universal' hair loss).

Universalis Alopecia Areata example. Loss of all hair. Face with no hair on the scalp or eyebrows.

There are also other types, but these are more related to the location or form of hair loss:

  • Diffuse Alopecia Areata:

Results in your hair thinning unexpectedly across your entire scalp (hence "diffuse", meaning to scatter across a wide area), instead of falling out in patches. It can be hard to diagnose since it looks like other types of hair loss.

Diffuse Alopecia Areata example. Scalp showing hair thinning.

  • Ophiasis Alopecia:

Leads to hair loss on the bottom back sides of your scalp in the shape of a band. It primarily affects your occipitotemporal scalp (occipital region being the back of your head, and the temporal region being the sides of your head and temples). Fun fact: it was named after the Greek word for snake, "ophis."

Ophiasis Alopecia. Back, bottom region of the scalp, missing hair.

Causes

Alopecia areata is caused by your immune system mistakenly attacking hair follicles. For some unknown reason to scientists, your immune system thinks that your hair follicles are foreign invaders (e.g., bacteria, viruses, fungi) that lead to infection, illness, and disease.


Other factors that play a role include:

-genetics

-other autoimmune diseases such as psoriasis, vitiligo, lupus erythematosus (causes inflammation and damage to skin, joints, and organs), or thyroid disease (when the thyroid gland makes too much or too little hormone, affecting metabolism)

-medication side effects

-allergic conditions' risk factors (e.g., asthma, hay fever, atopic dermatitis)

-even smoking has been linked

-nivolumab (brand name Opdivo), a cancer immunotherapy drug, can rarely cause it

-stress could also contribute


Treatments/Cure?

Unfortunately, there is no known cure for alopecia areata. However, there are several treatments that can help manage symptoms and aid hair regrowth. Treatments depend on what type of hair loss, how much, your age, previous treatments, and any other conditions.

Treatments that are effective work by blocking the immune system from attacking your hair follicles, allowing for hair growth.


Let's look at some of these treatments in question.


For mild or limited alopecia areata (small amount of hair loss), most just prefer to wear hair pieces, scarves, or hairstyles that hide the patches instead of treatments. That being said, treatments that do target this include:

  • Topical Corticosteroids → Corticosteroids are anti-inflammatory drugs that help reduce inflammation. They can be directly injected into your scalp, taken in the form of a pill, or, in this case, applied topically (applied directly onto skin as a cream, ointment, or foam).

    Pros: good option for those who can't take injections.

    Cons: possible slow response and side effects such as increased appetite, weight gain, mood changes, and blurred vision.

  • Intralesional Corticosteroids → most common treatment for adults with patchy alopecia areata. It's an injection that directly injects the medication into the areas where hair is missing.

    Pros: hair growth is seen within 6 to 8 weeks if successful.

    Cons: can be painful and uncomfortable for some, and temporary depressions or "dents", aka dells, can develop.

  • Minoxidil → most commonly used as a topical solution or foam, but pill prescriptions are also taken orally (by mouth) in some cases.

    Pros: around 12 weeks to see hair growth (topical form).

    Cons: pill form is usually not effective when used alone, and side effects such as headaches, abnormal hair growth, and scalp irritation.

  • Phototherapy → uses ultraviolet (UV) light from special lamps to treat the skin.

  • Phototherapy → blood is drawn from your body, processed to concentrate platelets (blood cells that help tissue repair and growth), and then injected into the scalp.

    Cons: pain, irritation, dizziness, nausea, and vomiting

Some of these treatments are often combined with others in order to achieve results.


Treatment for those who have moderate alopecia areata can include a combination of the previous treatments (topical corticosteroids with or without minoxidil). But in addition to that, there are:

  • Pulse Corticosteroids → corticosteroids that are given at high doses for a short period instead of a long time. They're usually given orally.

    Pros: have fewer side effects than long-term oral steroids.

    Cons: temporary and moderate gastrointestinal (related to the stomach and intestines) discomfort, headaches, dizziness, hypertension (high blood pressure), facial flushing (face reddening or warming), and palpitations (feeling like your heart is racing, pounding, or skipping a beat).

  • Topical or Contact Immunotherapy → a chemical that intentionally causes an allergic reaction to trigger hair regrowth. For some unknown reason, this changes your immune system's response at the hair follicles. It's usually used to treat severe, extensive alopecia, but it can also be used for moderate disease.

    Pros: hair growth is seen in 40 to 55% of patients.

    Cons: discomfort, redness, rashiness at the site, swollen lymph nodes (small glands that help filter harmful substances and fight infection), and eczema (a condition causing itchy, inflamed, or red skin).

  • Duplilumab (Dupixent) → a monoclonal antibody (a type of targeted therapy that modifies the immune system) that helps patients who also have eczema or atopic dermatitis (a type of eczema).


Finally, severe alopecia areata and, in some moderate cases, the holy grail of all treatments:

  • JAK (Janus Kinase) Inhibitors → drugs that modulate the immune system. They focus on the immune pathway that is overly active in alopecia areata. To put it simply, JAK proteins transmit signals that immune cells use to communicate and trigger the attack at the hair follicles. JAK inhibitors block these signals, stopping the attack and allowing hair regrowth. This treatment is considered the primary option for universalis alopecia and totalis alopecia.



Effects on Daily Life and Final Thoughts

For many of us, our hair is more than just about appearance. It's part of who we are. Our identity. Having that taken away can bring many changes to daily life. In a survey of 216 adults suffering from alopecia areata, 62% of them withdrew from activities, 54% reduced interaction with their friends, and 45% of those employed reported missing work because of their condition. As you can imagine, hair loss can lead one to feeling extremely self-conscious. Consuming thoughts about how you're perceived by others, along with the pressure to cover symptoms with wigs, makeup, hats, or scarves, adds a significant amount of stress. Many also face bullying or social judgment, which only worsens these burdens.


Raising awareness and showing compassion are the only ways for us to remove the stigma seen in society. To conclude, I want to leave you with a powerful message that Yvonne, a 3rd generation woman with alopecia areata, once said: "It's taken me a while, but I've had to learn to love myself with or without hair. My hair doesn't define me. It's who I am inside that matters."


patchy alopecia areata, showing hair with bald spots on the scalp
patchy alopecia areata, showing hair with bald spots on the scalp

Sources

Alopecia vs Alopecia Areata

Types of Alopecia Areata

Causes

Treatments/Cure?

Effects on Daily Life and Final Thoughts

Comments

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