Alopecia is often incredibly misunderstood and underdiscussed, even though it affects millions of people around the world. So what is alopecia? How can it affect your hair, and are there any treatments for it? Here’s everything you need to know about the autoimmune hair-loss disorder that can affect both women and men.
What is alopecia?
Alopecia refers generally to hair loss in parts of the body that usually have hair. There are generally three types:
Alopecia totalis: When a person loses all hair on the scalp.
Alopecia universalis: When a person loses all hair on their body, which is very rare.
Alopecia areata: When a person develops patchy baldness somewhere on their body (often in coin-sized patches), including the scalp, beard area, eyebrows, eyelashes, armpits, inside the nose, or ears. Alopecia areata is an autoimmune disease (more on that below).
For people with alopecia, baldness tends to be the only symptom, and typically their bald patches are smooth. There are other underlying conditions that may lead to hair loss — from thyroid disorders to cancer treatments — but that’s not the same as when hair loss is the primary diagnosis.
What causes alopecia?
It depends. Alopecia areata is an autoimmune condition, in which a person’s immune system attacks their hair follices leading to anything from a few quarter-sized patches to much greater baldness. It’s not totally clear what causes the immune system to act that way, but experts think it’s probably a combination of genetic and non-genetic factors as well as stress.
As the Cleveland Clinic says: “Alopecia areata is an unpredictable disease. In some people, hair grows back but falls out again later. In others, hair grows back and remains. Each case is unique.”
For other people, however, hair loss does not stem from autoimmune issues. The most common factor is stress and stressful life events, but plenty of other factors can play a role, including hairstyles that pull tightly, damaging hair treatments, nutritional deficiencies and hormonal changes can all cause alopecia. In some cases, it is not clear to a person experiencing alopecia — or their health care provider — why hair loss has occurred.
Does alopecia cause permanent hair loss?
It can, but many people with conditions related to alopecia do see their hair regrow. Hormonal changes, such as those during pregnancy or menopause, and medical conditions can cause both permanent and temporary hair loss.
For those with alopecia areata, hair more commonly regrows on its own in people with less extensive hair loss, people who saw an onset of alopecia at a later age, and those without a family history of the disease.
Who does alopecia affect?
It affects women and men equally. Estimates suggest that 1 of every 500 to 1,000 people have alopecia areata. However, while all people can experience hair loss, a 2018 study found that Black and Hispanic women have an increased risk of alopecia areata compared with non-Hispanic white women.
The psychological toll of alopecia
Alopecia can have serious psychosocial consequences, causing intense emotional suffering, and personal, social and work-related problems. It has also been linked with high levels of depression and anxiety. The latter is evident in the fact that many people who experience balding will try to hide it, as it’s a source of embarrassment for them.
What are the treatments for alopecia?
Alopecia areata cannot be cured, but there are treatment options that work for some people, but no single treatment has been shown to work for everyone. It may take a bit of trial and error.
One common option for alopecia areata is corticosteroids, which are anti-inflammatory drugs that may be given orally, as an ointment, or injected into the scalp or the area of the body that is affected like beard area, eyebrows, eyelashes, armpits, etc.
Minoxidil (otherwise known as Rogaine) may also help stimulate hair growth, as can the prescription medication finasteride (Propecia) for men.
Doctors might also consider certain medications used to treat other autoimmune conditions. Laser therapy is another option for those grappling with hereditary hair loss and some people have had good experiences with PRP (platelet-rich plasma) therapy.
Many times, treating alopecia comes down to trying to determine the underlying causes, then targeting those. If, for example, hair loss appears to be caused by emotional trauma, mental health experts may be able to help. If an underlying nutritional issue or hormonal changes are the issue, doctors will try to address those. Support groups can help people connect with others living with alopecia.
Talk to your doctor or dermatologist
If alopecia is a concern to you it is worth talking to your doctor or dermatologist. Before your visit, it may be helpful if you spend some time and make some notes about your specific circumstances. The Mayo Clinic recommends running through questions like: When did you first start experiencing hair loss? Has it been continuous or occasional? Has anyone in your immediate family experienced it, and what medications or supplements (if any) do you take?
The most important takeaway is to remember that you are not alone. Many people living with alopecia have become outspoken about the fact that their hair loss, whatever the root cause, does not define them… and it does not define you.