Bald Spots in Hair: Understanding Alopecia Areata & Causes of Sudden Patchy Hair Loss

What is Alopecia Areata? | Causes and Risk Factors | Types of Alopecia Areata | Symptoms: Recognizing Alopecia | Treatment Options | Lifestyle and Home Care Tips

Are you loosing entire patches of hair before you’re not even nearly old enough to start going bald? On the contrary to what you might believe, patchy hair loss is a common problem both young and old people face. Your bald patches can be due to ‘alopecia areata’, an immune mediated condition 2% of people experience at some point in their lives.^[1] Not only it is more common than you think, but also treatable. We are ready to help you understand alopecia areata in and out, and bring you tips to regain your confidence in your image.

Alopecia Areata causing sudden patchy hair loss on the scalp, a common autoimmune condition leading to bald spots.

What is Alopecia Areata?

Alopecia areata is an autoimmune disorder, meaning the body’s immune system mistakenly attacks its own hair follicles. The result is, sudden patchy hair loss. Most commonly, it appears as smooth, round patches of hair loss on the scalp, but it can affect any area with hair—even your eyebrows or beard. This condition affects both males and females equally.^[2] Interestingly, it is more common among children than adults, and 40% of people who get bald spots, get them before the age of 20.^[2]

The good news is that alopecia areata does not permanently damage the hair follicles, so hair can potentially grow back.^[3]

Causes and Risk Factors of Alopecia Areata

To really understand alopecia areata, we need to take a look at the hair cycle. Hair cycle describes the process of hair growth and renewal in 3 phases.

1. Anagen phase- Active hair growth in 6 stages (Stage I, II, III, IV, V, VI)
2. Catagen phase- Keratin deposition
3. Telogen phase- Period between regression of old hair follicles and beginning of new anagen phase

Further, some body parts like hair, eyes and central nervous system have ‘immune privileges’, which means they are usually protected from the immune system reacting to them, even if exposed to potential triggers. In alopecia areata, this immune privilege in hair follicles is lost. The immune system misfires and attacks the hair follicles. This halts this hair cycle in stage III or IV of the anagen phase, and pushes into catagen or telogen phase earlier than normal.^[3] This leads to patchy hair loss. It is like the body’s defense system gets confused, causing this unexpected reaction.

Research shows that this condition is often linked to other health problems, including skin conditions like vitiligo, psoriasis, and atopic dermatitis, as well as systemic issues like lupus, thyroid disease, and even hay fever (allergic rhinitis).^[4]

Certain groups are also more prone to developing alopecia areata. For instance, individuals with Down syndrome or a rare condition called polyglandular autoimmune syndrome type 1 face a higher risk.^[5],[6],[7] This highlights how alopecia areata is deeply connected to the body’s immune system and its overall health. Genetics play a big role in immune mechanism of alopecia areata, while environmental triggers potentially set off the condition. Common triggers include emotional or physical stress, viral infections, some medications, and even vaccinations.

Types of Alopecia Areata

There are several types of alopecia areata, based on the pattern of hair loss.

Symptoms: Recognizing Alopecia Areata by Bald Spots

Usually, you would notice a patchy hair loss on your scalp, that develops over a few weeks. However, it may involve beard, eyebrows, eyelashes, and extremities as well. A key sign of active disease is “exclamation-mark hairs,” which are hairs that are narrower at the base and found at the edges of hair loss patches. Few experience total loss of scalp hair, and 10-15% experience nail changes, including fine pitting, brittle or ridged nails, and discoloration. Interestingly, white hair is often spared, giving an illusion of sudden greying.

Here is a real-life case scenario to help you understand the presentation.

Case 1: I am a 29-year-old male. I’m trying to determine whether I’m exhibiting symptoms of male pattern baldness or just a mature hairline and whether I should be beginning a treatment such as Finasteride if I am I. The early stages. My brother is bald (started at 16 and advanced quickly) and my maternal grandfather was bald. My mom’s brother is bald but my father and his father are not.

Diagnosing Alopecia Areata

Diagnosis is made with the presence of typical clinical history and examination findings described above. Dermoscopy examination and hair pull tests help confirm alopecia areata. Additionally, nail examination gives supportive evidence, as some types of alopecia areata gives rise to nail changes. If the diagnosis still remains unclear, your dermatologist may suggest biopsy, where a small tissue sample will be taken from the skin at the outer edge of the patch of hair loss. It is important to consult a healthcare professional to properly diagnose alopecia areata, so correct treatment can be started early to prevent further hair loss.

Here is a real-life case scenario where a patient underwent significant duress because she was hesitant to consult a healthcare professional early. This highlights the necessity of accurate diagnosis as early as possible.

Case 2: I am a 29-year-old female. I’ve had an itchy scalp for about 8 years now. It usually gets really flaky and smelly. After washing the itching usually reduces but then several hours after the itch comes back. I recently got tired of the itching and shaved my head yesterday with a shaving stick. I have noticed bald patches of the scalp. At some point where the hair just fel off. I suspect that this is some kind of fungal infection. I’m hoping it’s not skin cancer. Now that I’ve shaved my head it only feels sore from the shaving but no itching yet. I’ve ordered some anti-fungal cream online to start applying. I should probably see a dermatologist but these are the steps I’ve taken so far. I hope it’s not scalp cancer.

Treatment Options for Alopecia Areata

50% people recover naturally within 1 year, without having to undergo any treament.^[3] For others, pharmacological and non-pharmacological treatment options are available.

Pharmacological:

Corticosteroids are the drug of choice for most cases, which is administered orally, topically or as an injection. Intralesional corticosteroids, like triamcinolone, can regrow hair in small patches within 6–8 weeks. Topical corticosteroids, such as betamethasone, are ideal for children or those avoiding injections. Severe cases may need topical immunotherapy or oral JAK inhibitors (e.g., baricitinib, ritlecitinib), which require ongoing use and may cause side effects. Topical immunotherapy uses allergens like DPCP to stimulate hair growth, with success rates varying based on the extent of hair loss. JAK inhibitors work by suppressing immune cells, but they carry risks like infections and cardiovascular issues.

Non-pharmacological:

Phototherapy can be used to stimulate hair re growth, while ultraviolet laser treatment is currently being used as a successful alternative to medication. Platelet rich plasma injections and supplements like quercetin are at the stage of early research.^[9] The results from these methods are inconsistent, and more research is needed to assess the benefits of the therapy.

Lifestyle and Home Care Tips

If you have alopecia areata, you will massively benefit from avoidance and reduction of triggering factors. Simple lifestyle modifications like using sun screen, wraparound sun glasses, head coverings (wigs, hats, scarves) for scalp protection from sun and temperature will help reduce active hair loss. Adding onions, garlic, and tea to your diet may help, as they are all natural sources of quercetin, which has antioxidant and anti-inflammatory properties.^[9] Stress management and avoiding harsh chemical preparations (eg: cosmetics, shampoo) on the affected area will also be beneficial.

Other Potential Causes of Bald Spots in Hair

Alopecia areata is not the only cause for hair loss. Other possible causes include fungal infections like taenia capitis, physical trauma, or deficiency of micronutrients like zinc. Therefore, proper diagnosis is essential to identify alopecia areata correctly.

Summary and Outlook

Alopecia areata is an unpredictable autoimmune condition characterized by patchy hair loss. Even though it lacks a definitive cure, there are various treatment options, from corticosteroids to immunotherapy and JAK inhibitors. Furthermore, as research into autoimmune diseases advances, exciting new treatments may emerge, offering hope for better management and potential breakthroughs in addressing this condition. So do not hesitate to consult your dermatologist to find out which treatment works best for you. With the right treatment and preventive measures, better days and fuller hair will be just around the corner.

Frequently Asked Questions (FAQ)

1. Can Alopecia Areata be cured?

Unfortunately, there is no permanent cure. However, many treatment options are available to manage symptoms and promote regrowth.

2. How quickly can hair grow back after treatment?

Response to treatment is highly variable from person to person. For example, intralesional steroid injections give results in 6 to 8 weeks, while JAK 2 inhibitors show results in 3 months in majority of people.³ Therapies are usually continued for 6 months before discontinuing. So, the hair regrowth will depend on treatment type and patient response.

3. Is Alopecia Areata contagious?

No, it is not contagious. Mechanism is completely immune mediated with significant genetic predisposition.

4. What’s the connection between stress and Alopecia?

While stress itself is not a causative factor, stress can trigger alopecia areata with episodes of active hair loss.