Alopecia Areata

What are these sudden bald patches? (Alopecia areata)

Alopecia areata is an autoimmune condition in which the immune system mistakenly targets hair follicles, causing smooth, round patches of hair loss, often appearing quite suddenly. The follicles are not destroyed, so regrowth is always possible, though the course of the condition is genuinely unpredictable and varies from person to person.

Is this you?

• One or more round or oval bald patches, often discovered by touch or by a hairdresser

• Skin in the patch that looks smooth and normal, without scale, redness or scarring

• Short, tapered hairs at the edge of a patch

• Patches that appeared over days or weeks rather than years

• Loss in the beard, brows or lashes, or new pitting and ridging in the nails

• Fine, pale regrowth appearing in an older patch

These symptoms overlap with other conditions, including fungal infection, traction alopecia and early scarring alopecias, so a patch alone cannot confirm the cause.

What is happening and why

In alopecia areata, immune cells that normally leave hair follicles alone begin attacking them, pushing hairs abruptly out of their growth phase. The follicles themselves survive. The immune system disrupts them rather than destroying them, which is why patches can regrow fully, sometimes without any treatment at all. It is well established that alopecia areata is autoimmune, and that it often runs alongside a personal or family history of other autoimmune conditions, such as thyroid disease. What triggers an individual episode is much less well understood.

The course is unpredictable, and it would be wrong to pretend otherwise. Many people have a single episode that regrows within a year. Some have patches that come and go. A smaller number progress to more extensive loss. No test currently predicts which path yours will take.

Other conditions can produce very similar patches, and telling them apart requires examining the scalp, which is what the assessment is for.

How I assess it

The appointment starts with your history. I will ask how quickly the patches appeared, whether you have had them before, about your general and family health, particularly any autoimmune and thyroid history, and how you are coping, because alopecia areata is as much an emotional event as a physical one.

I then examine the patches with trichoscopy. Under magnification, alopecia areata has characteristic features that distinguish it from fungal infection, traction damage or a scarring process, none of which can be reliably judged from a photo or a mirror. I will check your nails, since changes there can accompany the condition, and take clinical photographs so that activity and regrowth can be tracked properly over time. Where blood tests would be useful, thyroid function is a common example, I can arrange testing, or request it through your GP.

My role in alopecia areata is specific: accurate assessment, ongoing support and scalp care, objective monitoring, and referral to your GP or a dermatologist where medical treatment is appropriate.

Treatment options, and why the right one depends on the cause

Well established approaches. It is well established that some patches regrow without intervention. Medical treatments also exist, including steroid based options and, for more extensive disease, newer prescription medicines, available through your GP or a dermatologist. Which of these is relevant depends on the extent and activity of your condition, which is what assessment establishes.

In clinic support. The evidence for in clinic therapies in alopecia areata is more limited than in other types of hair loss, and I will not pretend otherwise. Where supportive scalp care has a role, I will discuss it with you at assessment.

Self care and camouflage. Scalp protection, styling and camouflage approaches, and support for the emotional side of an unpredictable condition, including patient communities, can all make a real difference. What helps most depends on your situation.

See also: telogen effluvium and scalp conditions.

When to see your GP

If patches are appearing or spreading quickly, it is worth acting promptly rather than waiting, because medical treatment options are widest early. See your GP if you have symptoms that can accompany thyroid trouble, such as fatigue, weight change or palpitations. Where anything I find at assessment needs medical treatment, I will refer you to your GP or a dermatologist and coordinate that referral.

Getting help in Ipswich and Suffolk

I am based in Ipswich and support people from across Suffolk, including Woodbridge, Felixstowe, Stowmarket and Bury St Edmunds. A sudden bald patch is frightening, and the internet will offer you five contradictory explanations for it. The way to know which condition is actually behind your patch, and whether you need a dermatologist, reassurance, or both, is to examine the scalp properly. That is what a consultation is for. You can book your consultation whenever you are ready.