Sudden round patches of hair loss or severe excess shedding of scalp hair could be a sign of alopecia areata.
Alopecia areata is a common condition that can affect anyone at any age, often causing distress due to its unpredictable nature. We’re here to guide you through understanding and managing this condition with expert care.
It is an autoimmune condition causing non-scarring hair loss, meaning hair follicles remain intact with potential for regrowth. It typically presents as small, coin-sized, round bald patches on the scalp, but can also affect the beard, eyebrows, eyelashes, or body hair. There is a rarer diffuse form of alopecia areata that is spread throughout the scalp. It is important to consider this if there is rapid, acute hair shedding or significant loss of hair volume over a short time.
Variants of alopecia areata include:
- Alopecia totalis: Complete scalp hair loss.
- Alopecia universalis: Total hair loss on the scalp and body.
It can affect all genders, ages, and ethnicities, with nail changes like pitting observed in some cases.
It can affect all genders, ages, and ethnicities, with nail changes like pitting observed in some cases.
Common Signs & Symptoms
- Sudden, round patches of hair loss on the scalp or body.
- Itching, burning, or tingling in affected areas before or after hair loss.
- Nail pitting, brittleness, or breakage resembling thimble dimples.
- Short, tapered “exclamation mark” hairs at the edge of bald patches.
- Eye dryness or irritation if eyelashes are affected, especially in windy conditions.
What Causes It?
Alopecia areata occurs when the immune system mistakenly attacks hair follicles, causing inflammation and hair loss. The exact trigger is unknown, but possible factors include:
- Genetic predisposition: About 20% of those affected have a family history.
- Other autoimmune conditions: Linked to thyroid disease, vitiligo, type 1 diabetes, or atopic conditions like eczema.
- Stress or infections: May act as triggers in some cases, though not consistently.
Get Started with Alopecia Areata Recovery Journey
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“Thanks goodness for Dr Ali, I certainly wouldn’t be where I am today without her. By far the best doctor I’ve ever come across in my life, so knowledgeable, calming, honest, professional, kind and down to earth. She saved me from being robbed of my hair through alopecia and I’ll be forever grateful.“
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Treatment Options
We offer personalised treatment plans to manage alopecia areata, focusing on finding the fastest route to hair regrowth and recovery.
Topical treatments:
- Local steroid injections: Most effective for small patches on the scalp or brows, repeated every 6 weeks until full recovery.
- Corticosteroid creams/shampoo applied to bald patches for 6 weeks – often prescribed in primary care but not always effective.
- Minoxidil lotion to boost regrowth in combination with other therapies.
- Prostaglandin analogues (e.g., latanoprost) for eyebrow/eyelash regrowth.
Local steroid injections:
- Most effective for small patches on the scalp or brows, repeated every 4-6 weeks.
Oral treatments:
- Immunosuppressants (e.g., methotrexate, ciclosporin, azathioprine)
- JAK inhibitors (e.g., ritlecitinib, NHS-funded for severe cases; other JAK used off-licence)
- Corticosteroid tablets for acutely progressive disease or severe cases (usually for short-term use only).
- Oral minoxidil
Psychological support:
- Improve well-being and reduce stress factors
Each treatment plan is customised to your needs, balancing efficacy and safety.
What to Expect with Treatment
- For single, solitary patches or limited patches (<5), the prognosis is generally good. Hair regrowth is usually seen six weeks after a course of scalp steroid injection.
- Larger areas of hair loss (30% of scalp or more) can take several months/years to recover fully, depending on the treatment regimen and the response rate.
- Beard alopecia generally responds rapidly to steroid injection
We guide you with realistic timelines, ongoing monitoring, and emotional support.
Our Diagnostic Approach
A careful medical history is taken to understand the course of alopecia, the speed of onset and additional medical factors such as thyroid disease, family history or nutritional deficiency
Intralesional steroid injection, supplements, minoxidil are the most common treatments. More complex cases will need tablet treatment to suppress the immune system.
We guide you with realistic timelines, ongoing monitoring, and emotional support.
Clinical examination to assess hair loss patterns and symptoms.
Non-invasive Trichoscopy Scalp Imaging to evaluate hair follicles and scalp health. Clinical photos are taken to monitor and record progress.
Blood tests are ordered if appropriate usually to test thyroid function, Vitamin D, B12, Folic acid, Ferritin, iron studies.
More tests are ordered if there is suspicion of coeliac disease or treatment with immunosuppressive drugs is planned.
Scalp biopsy (if needed): required in rare occasion to confirm diagnosis in uncertain cases
A careful treatment plan is organised based on the clinical findings.
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