Quick answer
What is alopecia areata?
Alopecia areata is an autoimmune condition causing sudden hair loss, usually in round or oval patches on the scalp. It can also affect eyebrows, eyelashes, beard, and body hair. It is not contagious and the hair follicles remain alive — hair can regrow, sometimes without treatment. About 1 in 50 people experience alopecia areata at some point. NHS treatments include topical steroids, steroid injections, and minoxidil; severe cases may need specialist immunotherapy.
Alopecia areata — patchy autoimmune hair loss
Alopecia areata is an autoimmune condition in which the immune system attacks hair follicles, causing sudden hair loss — usually in smooth, round or oval patches on the scalp.
It affects roughly 1 in 50 people at some point in life. It is not contagious, not dangerous, and not caused by poor hair care — though the emotional impact can be significant.
What it looks like
- Smooth, round bald patches on the scalp — often appearing overnight
- Exclamation mark hairs — short broken hairs narrower at the base — at patch edges
- Loss of eyebrows, eyelashes, or beard hair
- Nail pitting or ridging in some people
In most cases, hair follicles remain alive beneath the skin — meaning regrowth is possible.
Types and severity
Patchy alopecia areata — one or more bald patches; most common form.
Alopecia totalis — complete scalp hair loss.
Alopecia universalis — loss of all body hair including eyebrows and eyelashes.
Ophiasis — loss in a band around the sides and lower back of the scalp — often more treatment-resistant.
Causes and associations
The immune system mistakenly targets hair follicles. Contributing factors:
- Genetics — family history in roughly 20% of cases
- Other autoimmune conditions — thyroid disease, vitiligo, type 1 diabetes
- Triggers — stress, viral illness, or physical trauma may precipitate episodes
Your GP may check thyroid function and discuss associated conditions.
Diagnosis
Usually diagnosed by appearance — characteristic smooth patches without scarring. A GP or dermatologist examines the scalp and nails. Blood tests exclude other causes such as iron deficiency or thyroid disease. Biopsy is rarely needed.
Important: Scarring, scaling, or burning on the scalp suggests a different condition — not alopecia areata.
NHS treatment
Limited patchy disease
Many patches regrow spontaneously within 12 months — watchful waiting is reasonable.
Active treatment options:
- Potent topical corticosteroids — applied to patches
- Intralesional steroid injections — triamcinolone injected into patch borders
- Topical minoxidil — may support regrowth
Extensive disease
Contact immunotherapy — DPCP applied to scalp at specialist centres — stimulates regrowth in some patients.
JAK inhibitors — baricitinib approved for severe alopecia areata — available through specialist prescription.
Wigs — NHS prescription available when hair loss causes significant distress.
Living with alopecia areata
Hair loss is unpredictable — patches may regrow, new patches may appear, or hair may fall out again. Support includes:
- Dermatology follow-up for extensive or treatment-resistant disease
- Wig and hairpiece services on NHS prescription
- Talking therapies for anxiety and self-esteem
- Patient support organisations for peer connection
See hair loss for other causes of thinning hair and underactive thyroid — a treatable condition that can also cause diffuse hair shedding.
Common questions
- What causes alopecia areata?
- Alopecia areata is an autoimmune condition — the body's immune system mistakenly attacks hair follicles, causing hair to fall out in patches. Genetics play a role — it runs in families. It is associated with other autoimmune diseases including thyroid disorders, vitiligo, and type 1 diabetes. Stress may trigger episodes in susceptible people but does not cause the condition.
- Will my hair grow back?
- Often yes. Many people with a few patches see full regrowth within a year without treatment. Regrowth may be white or fine initially, then return to normal colour and thickness. However, alopecia areata is unpredictable — some people have recurring patches, and extensive forms may be harder to treat.
- What are the types of alopecia areata?
- Patchy alopecia areata — one or more round bald patches on the scalp. Alopecia totalis — total scalp hair loss. Alopecia universalis — loss of all body hair. Ophiasis — band-like loss around the sides and back of the scalp. Extensive forms are less common and harder to treat.
- What treatments are available on the NHS?
- For limited patchy disease, watchful waiting is reasonable as hair often regrows. Active treatment includes potent topical corticosteroids, intralesional steroid injections into patches, topical minoxidil, and contact immunotherapy (DPCP) at specialist centres. Wigs are available on NHS prescription when hair loss causes significant distress.
- Is alopecia areata contagious?
- No. You cannot catch alopecia areata from another person. It is not caused by infection, poor diet, or hair care products — though harsh styling can worsen apparent thinning.
- Can children get alopecia areata?
- Yes — it commonly first appears in childhood or teenage years. Children are referred to dermatology for assessment and treatment. School support and counselling help children cope with visible hair loss.
- How does alopecia areata affect mental health?
- Sudden visible hair loss can cause significant anxiety, low self-esteem, and social withdrawal. NHS talking therapies, support groups, and wig services help. Discuss emotional impact with your GP — psychological support is a valid part of treatment.