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January 2012

Questions and Answers about

Alopecia Areata

This booklet contains general information

about alopecia areata (al-oh-PEE-shah ar-eeAH-tah). It describes what alopecia areata is,

its causes, and treatment options. Information

is also provided on current research. At the

end is a list of key words to help you

understand the terms in this booklet. If you

have further questions after reading this

booklet, you may wish to discuss them with

your doctor.

Alopecia areata is just one cause of alopecia,

or hair loss. This booklet deals only with

alopecia areata.

What Is Alopecia Areata?

Alopecia areata is considered an autoimmune

disease, in which the immune system, which is

designed to protect the body from foreign

invaders such as viruses and bacteria,

mistakenly attacks the hair follicles, the

structures from which hairs grow. This can

lead to hair loss on the scalp and elsewhere.

In most cases, hair falls out in small, round

patches about the size of a quarter. In many

cases, the disease does not extend beyond a

few bare patches. In some people, hair loss is

more extensive. Although uncommon, the

disease can progress to cause total loss of

hair on the scalp (referred to as alopecia

areata totalis) or complete loss of hair on the

scalp, face, and body (alopecia areata

universalis).

What Causes It?

Who Is Most Likely to Get It?

Is My Hair Loss a Symptom of a

Serious Disease?

Can I Pass It On to My Children?

Will My Hair Ever Grow Back?

What Can I Expect Next?

How Is It Treated?

How Will Alopecia Areata Affect My

Share

Questions and Answers About Alopecia Areata http://www.niams.nih.gov/Health_Info/Alopecia_Areata/default.asp

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Life?

How Can I Cope With the Effects of

This Disease?

What Are Some Promising Areas of

Research?

Where Can People Find More

Information About Alopecia Areata?

Key Words

What Causes It?

In alopecia areata, immune system cells called

white blood cells attack the rapidly growing

cells in the hair follicles. The affected hair

follicles become small and drastically slow

down hair production. Fortunately, the stem

cells that continuously supply the follicle with

new cells do not seem to be targeted. So the

follicle always has the potential to regrow hair.

Scientists do not know exactly why the hair

follicles undergo these changes, but they

suspect that a combination of genes may

predispose some people to the disease. In

those who are genetically predisposed, some

type of trigger—perhaps a virus or something

in the person’s environment—brings on the

attack against the hair follicles.

Who Is Most Likely to Get It?

Alopecia areata affects nearly 2 percent of

Americans of both sexes and of all ages and

ethnic backgrounds. It often begins in

childhood.

If you have a close family member with the

disease, your risk of developing it is slightly

increased. If your family member lost his or her

first patch of hair before age 30, the risk to

other family members is greater. Overall, one

in five people with the disease has a family

member who has it as well.

Is My Hair Loss a Symptom of a

Serious Disease?

Alopecia areata is not a life-threatening

disease. It does not cause any physical pain,

and people with the condition are generally

healthy otherwise. But for most people, a

disease that unpredictably affects their

appearance the way alopecia areata does is a

serious matter.

The effects of alopecia areata are primarily

socially and emotionally disturbing. In alopecia

Questions and Answers About Alopecia Areata http://www.niams.nih.gov/Health_Info/Alopecia_Areata/default.asp

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universalis, however, loss of eyelashes and

eyebrows and hair in the nose and ears can

make the person more vulnerable to dust,

germs, and foreign particles entering the eyes,

nose, and ears.

Alopecia areata often occurs in people whose

family members have other autoimmune

diseases, such as type 1 diabetes, rheumatoid

arthritis, thyroid disease, systemic lupus

erythematosus, pernicious anemia, or

Addison’s disease. People who have alopecia

areata do not usually have other autoimmune

diseases, but they do have a higher

occurrence of thyroid disease, atopic eczema,

nasal allergies, and asthma.

Can I Pass It On to My Children?

It is possible for alopecia areata to be

inherited. However, most children with alopecia

areata do not have a parent with the disease,

and the vast majority of parents with alopecia

areata do not pass it along to their children.

Alopecia areata is not like some genetic

diseases in which a child has a 50–50 chance

of developing the disease if one parent has it.

Scientists believe that there may be a number

of genes that predispose certain people to the

disease. It is highly unlikely that a child would

inherit all of the genes needed to predispose

him or her to the disease.

Even with the right (or wrong) combination of

genes, alopecia areata is not a certainty. In

identical twins, who share all of the same

genes, the concordance rate is only 55

percent. In other words, if one twin has the

disease, there is only a 55-percent chance that

the other twin will have it as well. This shows

that other factors besides genetics are

required to trigger the disease.

To learn more about the genes and other

factors involved in alopecia areata risk, the

National Institute of Arthritis and

Musculoskeletal and Skin Diseases (NIAMS)

sponsored the development of an alopecia

areata registry. (For more information about

the registry, see “What Are Some Promising

Areas of Research?”)

Will My Hair Ever Grow Back?

There is every chance that your hair will

regrow with or without treatment, but it may

also fall out again. No one can predict when it

might regrow or fall out. The course of the

Questions and Answers About Alopecia Areata http://www.niams.nih.gov/Health_Info/Alopecia_Areata/default.asp

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disease varies from person to person. Some

people lose just a few patches of hair, then the

hair regrows, and the condition never recurs.

Other people continue to lose and regrow hair

for many years. A few lose all the hair on the

scalp; some lose all the hair on the scalp, face,

and body. Even in those who lose all their hair,

the possibility for full regrowth remains.

In some, the initial hair regrowth is white, with

a gradual return of the original hair color. In

most, the regrown hair is ultimately the same

color and texture as the original hair.

What Can I Expect Next?

The course of alopecia areata is highly

unpredictable, and the uncertainty of what will

happen next is probably the most difficult and

frustrating aspect of the disease. You may

continue to lose hair, or your hair loss may

stop. The hair you have lost may or may not

grow back, and you may or may not continue

to develop new bare patches.

How Is It Treated?

Although there is neither a cure for alopecia

areata nor drugs approved for its treatment,

some people find that medications approved

for other purposes can help hair grow back, at

least temporarily. The following are some

treatments for alopecia areata. Keep in mind

that although these treatments may promote

hair growth, none of them prevent new patches

or actually cure the underlying disease.

Consult your health care professional about

the best option for you. A combination of

treatments may work best. Ask how long the

treatment may last, how long it will take before

you see results, and about the possible side

effects.

Corticosteroids. Corticosteroids are

powerful antiinflammatory drugs similar

to a hormone called cortisol, which is

produced in the body. Because these

drugs suppress the immune system if

given orally, they are often used in the

treatment of various autoimmune

diseases, including alopecia areata.

Corticosteroids may be administered in

three ways for alopecia areata:

Local injections. Injections of

steroids directly into hairless

patches on the scalp, and

sometimes the brow and beard

areas, are effective in

increasing hair growth in most

Questions and Answers About Alopecia Areata http://www.niams.nih.gov/Health_Info/Alopecia_Areata/default.asp

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people, and are the most

common treatment in adults in

the United States. Injections

deliver small amounts of

cortisone to affected areas,

avoiding the more serious side

effects encountered with

long-term oral use. Side effects

may include transient pain, as

well as temporary depressions

in the skin that usually fill in by

themselves.

Oral corticosteroids.

Corticosteroids taken by mouth

are a mainstay of treatment for

many autoimmune diseases

and may be used in extensive

alopecia areata. But because of

the risk of side effects of oral

corticosteroids, such as

hypertension, weight gain,

osteoporosis, and cataracts,

they are used only occasionally

for alopecia areata and for

short periods of time.

Topical ointments. Ointments

or creams containing steroids

rubbed directly onto the

affected area are less traumatic

than injections and, therefore,

are sometimes preferred for

children. However,

corticosteroid ointments and

creams alone are less effective

than injections.

Minoxidil (5 percent). Topical

minoxidil solution promotes hair growth

in several conditions in which the hair

follicle is small and not growing to its

full potential. Minoxidil is approved by

the U.S. Food and Drug Administration

(FDA) for treating male and female

pattern hair loss. It may also be useful

in promoting hair growth in alopecia

areata. The topical solution, applied

twice daily, has been shown to promote

hair growth in both adults and children,

and may be used on the scalp,

eyebrow, and beard areas.

Anthralin. Anthralin, a synthetic tar-like

substance that alters immune function

in the affected skin, is an approved

treatment for psoriasis. Anthralin is also

commonly used to treat alopecia

areata. It is applied topically.

Questions and Answers About Alopecia Areata http://www.niams.nih.gov/Health_Info/Alopecia_Areata/default.asp

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Topical sensitizers. Topical

sensitizers are medications that, when

applied to the scalp, provoke an

allergic reaction that leads to itching,

scaling, and eventually hair growth.

Two topical sensitizers are used in

alopecia areata: squaric acid dibutyl

ester (SADBE) and

diphenylcyclopropenone (DPCP). They

should be administered by doctors

familiar with these products.

Photochemotherapy. In

photochemotherapy, a treatment used

most commonly for psoriasis, a person

is given a light-sensitive drug called a

psoralen either orally or topically and

then exposed to an ultraviolet light

source. This combined treatment is

called PUVA. Patients must go to a

treatment center where the equipment

is available at least two to three times

per week. If used for long periods, the

treatment may increase the risk of

developing skin cancer.

Alternative therapies. When drug

treatments fail to bring sufficient hair

regrowth, some people turn to

alternative therapies. Alternatives

purported to help alopecia areata

include acupuncture, aromatherapy,

evening primrose oil, zinc and vitamin

supplements, and Chinese herbs. Most

alternative therapies are not backed by

clinical trials, and because hair can

regrow spontaneously in alopecia

areata, it is difficult to evaluate the

effectiveness of these alternatives.

Furthermore, just because these

therapies are natural does not mean

that they are safe. As with any therapy,

it is best to discuss these treatments

with your doctor before you try them.

In addition to treatments to help hair grow,

there are measures that can be taken to

minimize the effects of excessive sun exposure

or discomforts of lost hair.

Sunscreens are important for the scalp,

face, and all exposed areas.

Eyeglasses (or sunglasses) protect the

eyes from excessive sun and from dust

and debris when eyebrows or

eyelashes are missing.

Wigs, caps, or scarves protect the

scalp from the sun and keep the head

Questions and Answers About Alopecia Areata http://www.niams.nih.gov/Health_Info/Alopecia_Areata/default.asp

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warm.

An ointment applied inside the nostrils

keeps them moisturized and helps to

protect against organisms invading the

nose when nostril hair is missing.

How Will Alopecia Areata Affect My

Life?

This is a common question, particularly for

children, teens, and young adults who are

beginning to form lifelong goals and who may

live with the effects of alopecia areata for many

years. The comforting news is that alopecia

areata is not a painful disease and does not

make people feel sick physically. It is not

contagious, and people who have the disease

are generally healthy otherwise. It does not

reduce life expectancy and it should not

interfere with going to school, playing sports

and exercising, pursuing any career, working,

marrying, and raising a family.

The emotional aspects of living with hair loss,

however, can be challenging. Many people

cope by learning as much as they can about

the disease, speaking with others who are

facing the same problem, and, if necessary,

seeking counseling to help build a positive

self-image.

How Can I Cope With the Effects of

This Disease?

Living with hair loss can be difficult, especially

in a culture that views hair as a sign of youth

and good health. Even so, most people with

alopecia areata are well-adjusted, contented

people living full lives.

The key to coping is valuing yourself for who

you are, not for how much hair you have or

don’t have. Many people learning to cope with

alopecia areata find it helpful to talk with other

people who are dealing with the same

problems. Nearly 2 percent of Americans have

this disease at some point in their lives, so you

are not alone. If you would like to be in touch

with others with the disease, the National

Alopecia Areata Foundation (NAAF) can help

through its pen pal program, message boards,

annual conference, and support groups that

meet in various locations nationwide. To find

contact information for NAAF and other

organizations that can help people with

alopecia areata, see “Where Can People Find

More Information About Alopecia Areata?”

Questions and Answers About Alopecia Areata http://www.niams.nih.gov/Health_Info/Alopecia_Areata/default.asp

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Another way to cope with the disease is to

minimize its effects on your appearance. If you

have extensive hair loss, a wig or hairpiece

can look natural and stylish. For small patches

of hair loss, a hair-colored powder, cream, or

crayon applied to the scalp can make hair loss

less obvious by eliminating the contrast

between the hair and the scalp. Skillfully

applied eyebrow pencil can mask missing

eyebrows.

Children with alopecia areata may prefer to

wear bandanas or caps. There are many

styles available to suit a child’s interest and

mood. It is often helpful if a parent informs

teachers, coaches, and others that the child

has alopecia areata, that it is not contagious,

and that the child is healthy.

For women, attractive scarves can hide patchy

hair loss, and proper makeup can camouflage

the effects of lost facial hair. If you would like to

learn more about camouflaging the cosmetic

aspects of alopecia areata, ask your doctor or

members of your local support group to

recommend a cosmetologist who specializes in

working with people whose appearance is

affected by medical conditions.

What Are Some Promising Areas of

Research?

Although a cure is not imminent, researchers

are making headway toward a better

understanding of the disease. This increased

understanding will likely lead the way to better

treatments for alopecia areata and eventually a

way to cure it or even prevent it.

The National Institutes of Health (NIH) and

other organizations support research into the

disease and its treatment. Here are some

promising areas of research:

Developing animal models. This is a

critical step toward understanding any

disease, and much progress has been

made. Researchers have identified an

inbred strain of mice that

spontaneously develops a condition

similar to the adult-onset form of

alopecia areata. By studying mice with

a disease similar to human alopecia

areata, researchers hope to learn more

about the mechanism of the disease

and eventually develop immune system

treatments for the disease in people.

Studying hair follicle development.

Questions and Answers About Alopecia Areata http://www.niams.nih.gov/Health_Info/Alopecia_Areata/default.asp

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By studying how hair follicles form in

mouse embryos, researchers hope to

gain a better understanding of hair

growth cycle biology that may lead to

treatments for the underlying disease

process.

Understanding stem cell biology.

Epithelial stem cells are immature cells

that are responsible for regenerating

and maintaining a variety of tissues,

including the skin and the hair follicles.

Stem cells in the follicle appear to be

spared from injury in alopecia areata,

which may explain why the potential for

regrowth is always there in people with

the disease. By studying the biology of

these cells, scientists hope to gain a

better understanding of factors that

trigger the disease.

Finding genes. Scientists are studying

the possible genetic causes and

mechanisms of the disease both in

families that have one or more people

with the disease and in the general

population. They look at families with

three or more affected individuals and

then look at large numbers of unrelated

affected people and compare their

genetic markers with unaffected

people; this is called a “genomewide

association study” or “GWAS.”

Scientists have identified genetic

variations associated with the

development of alopecia areata. They

also discovered that alopecia areata

has genetic similarities to other

autoimmune diseases, namely type 1

diabetes, rheumatoid arthritis, and

celiac disease. An understanding of the

genetics of the disorder will aid in

disease prevention, early intervention,

and development of specific therapies.

To assist researchers searching for

such genetic clues, the NIAMS

sponsored the development of the

National Alopecia Areata Registry, a

network of five centers, to identify and

register patients with the disease and

collect information and blood samples

(which contain genes). Data, including

genetic information, is made available

to researchers studying the genetic

basis and other aspects of the disease

and disease risk. For more information,

log onto the registry website at

www.AlopeciaAreataRegistry.org.

Questions and Answers About Alopecia Areata http://www.niams.nih.gov/Health_Info/Alopecia_Areata/default.asp

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More information on research is available from

the following resources:

ClinicalTrials.gov offers up-to-date

information for locating federally and

privately supported clinical trials for a

wide range of diseases and conditions.

Website: www.clinicaltrials.gov

NIH Clinical Research Trials and

You helps people learn more about

clinical trials, why they matter, and how

to participate.

Website: www.nih.gov/health

/clinicaltrials

NIH RePORTER is an electronic tool

that allows users to search a repository

of both intramural and extramural

NIH-funded research projects from the

past 25 years and access publications

(since 1985) and patents resulting from

NIH funding.

Website: www.projectreporter.nih.gov

PubMed is a free service of the U.S.

National Library of Medicine that lets

you search millions of journal citations

and abstracts in the fields of medicine,

nursing, dentistry, veterinary medicine,

the health care system, and preclinical

sciences.

Website:

www.ncbi.nlm.nih.gov/pubmed

Where Can People Find More

Information About Alopecia Areata?

You can get additional information through the

following organizations:

National Institute of Arthritis and

Musculoskeletal and Skin Diseases

(NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-0001

Phone: 301-495-4484

Toll Free: 877-22-NIAMS (877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

Website: http://www.niams.nih.gov

Other Resources

National Center for Complementary and

Alternative Medicine

National Institutes of Health

Questions and Answers About Alopecia Areata http://www.niams.nih.gov/Health_Info/Alopecia_Areata/default.asp

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Website: http://nccam.nih.gov

National Alopecia Areata Foundation

(NAAF)

Website: http://www.naaf.org

American Academy of Dermatology (AAD)

Website: http://www.aad.org

American Hair Loss Council

Website: http://www.ahlc.org

For additional contact information, visit the

NIAMS website or call the NIAMS Information

Clearinghouse.

Key Words

Acupuncture. A traditional Chinese system of

healing in which symptoms are relieved by

inserting needles beneath the skin at selected

points and then stimulating the points by

rotating the needles or exposing them to heat

or electrical current.

Addison’s disease. A condition that occurs

when the adrenal glands (a pair of glands

situated on top of the kidneys) fail to secrete

enough corticosteroid hormones. Without

treatment, the disease can be fatal.

Alopecia areata. An autoimmune, often

reversible disease in which loss of hair occurs

in sharply defined areas usually involving the

scalp or beard, but any area of the body where

hair grows can be affected.

Alopecia areata totalis. A form of alopecia

areata characterized by the total loss of hair on

the scalp.

Alopecia areata universalis. A form of

alopecia areata in which all hair on the scalp,

face, and body is lost.

Aromatherapy. The therapeutic use of

essential oils (highly concentrated aromatic

extracts distilled from a variety of aromatic

plant materials including grasses, leaves,

flowers, needles and twigs, fruit peels, wood,

and roots) to promote the health of body, mind,

and spirit.

Autoimmune disease. A disease that results

when the immune system mistakenly attacks

the body’s own tissues. Rheumatoid arthritis,

systemic lupus erythematosus, and type 1

diabetes are autoimmune diseases (“auto”

means self).

Questions and Answers About Alopecia Areata http://www.niams.nih.gov/Health_Info/Alopecia_Areata/default.asp

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Chemotherapy. The use of strong drugs to

suppress the immune system. Though

originally associated with cancer treatment,

chemotherapy is used for many different

diseases involving the immune system.

Corticosteroids. Potent anti-inflammatory

hormones that are made naturally in the body

or synthetically (man-made) for use as drugs.

They are also called glucocorticoids. The most

commonly prescribed drug of this type is

prednisone.

Diabetes. A disease in which the body does

not produce or properly use insulin, a hormone

that is necessary to convert sugar, starches,

and other food into energy.

Evening primrose oil. The oil of a weedy

plant containing the essential fatty acid gamma

linolenic acid (GLA), which is converted into

anti-inflammatory agents by the body. Evening

primrose oil is available as a nutritional

supplement and touted as a pain and

inflammation reliever.

Hair follicle. A small, narrow, tube-like

structure in the skin from which hair grows.

Immune system. A complex network of

specialized cells and organs that work together

to defend the body against attacks by “foreign”

invaders such as bacteria and viruses. In some

autoimmune conditions, it appears that the

immune system does not function properly and

may attack the body’s own tissues by mistake.

Pernicious anemia. A potentially dangerous

form of anemia, usually caused by an

autoimmune process, which results in a

deficiency of vitamin B-12.

Rheumatoid arthritis. An autoimmune

disease that targets primarily the membrane

lining the joints, leading to pain, stiffness,

swelling, and joint deformity.

Systemic lupus erythematosus. A chronic

autoimmune disease of the connective tissue

that can attack and damage the skin, joints,

blood vessels, and internal organs.

Topical sensitizers. Medications that, when

applied to the scalp, provoke an allergic

reaction that leads to itching, scaling, and

often hair growth. They include squaric acid

dibutyl ester and diphenylcyclopropenone.

Acknowledgments

Questions and Answers About Alopecia Areata http://www.niams.nih.gov/Health_Info/Alopecia_Areata/default.asp

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The NIAMS gratefully acknowledges the

assistance of the following individuals in the

preparation and review of previous versions of

this booklet: George Cotsarelis, M.D.,

University of Pennsylvania Medical Center,

Philadelphia; Vicki Kalabokes, National

Alopecia Areata Foundation, San Rafael, CA;

Alan Moshell, M.D., NIAMS, NIH; and David

Norris, M.D., University of Colorado Health

Sciences Center, Denver. A special

acknowledgement goes to Vera Price, M.D.,

University of California, San Francisco, for

assistance in the preparation of an updated

version of this booklet. Mary Anne Dunkin was

the original author of a previous version of this

booklet.

For Your Information

This publication contains information about

medications used to treat the health condition

discussed here. When this publication was

developed, we included the most up-to-date

(accurate) information available. Occasionally,

new information on medication is released.

For updates and for any questions about any

medications you are taking, please contact

U.S. Food and Drug Administration

Toll Free: 888–INFO–FDA

(888–463–6332)

Website: http://www.fda.gov

For additional information on specific

medications, visit Drugs@FDA at

www.accessdata.fda.gov/scripts

/cder/drugsatfda. Drugs@FDA is a

searchable catalog of FDA-approved

drug products.

For updates and questions about statistics,

please contact

Centers for Disease Control and

Prevention’s National Center for

Health Statistics

Website: http://www.cdc.gov/nchs

This publication is not copyrighted. Readers

are encouraged to duplicate and distribute as

many copies as needed.

Additional copies of this publication are

available from:

National Institute of Arthritis and

Musculoskeletal and Skin Diseases

(NIAMS)

Questions and Answers About Alopecia Areata http://www.niams.nih.gov/Health_Info/Alopecia_Areata/default.asp

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Information Clearinghouse

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-0001

Phone: 301-495-4484

Toll Free: 877-22-NIAMS

(877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

Website: http://www.niams.nih.gov

NIH Publication No. 12-5143

Many of our publications are

available in print. Would you like to

order publications on skin

disorders to be mailed to you? Visit

our online order form.

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