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Alopecia Areata - Patchy Hair Loss with Unpredictable Course

Written by
Dr. Suvash Sahu
and medically reviewed by iCliniq medical review team.

Published on Oct 29, 2016 and last reviewed on Oct 20, 2022   -  2 min read


Alopecia areata is a common form of hair loss affecting the quality of life of many patients. Here, I have discussed the causes, presentation and management of this disease.

Alopecia Areata - Patchy Hair Loss with Unpredictable Course

Alopecia areata is a unique self-limiting disorder characterized by areas of asymptomatic, non-scarring and non-inflammatory hair loss, commonly involving the scalp.


Alopecia areata presents as a localized patchy hair loss. Usually, the patch will be smooth and well circumscribed and often noticed by chance. It is an autoimmune disorder affecting the hair follicles and it is often associated with other autoimmune disorders like thyroid diseases, vitiligo, etc.

Types of Alopecia

Alopecia is of three types.

  1. Alopecia totalis - Loss of all the scalp hair.
  2. Alopecia universalis - Loss of hair from all hair bearing areas.
  3. Alopecia ophiasis - Loss of hair from the margins of the scalp.

Course of Alopecia

The course is unpredictable. Some patients may show complete recovery whereas in others the regrowth never takes place. Early age of onset, alopecia ophiasis and severe nail involvement have a poor prognosis.

Clinical Features

There are well-defined single or multiple round to oval areas of hair loss, which can affect any hair bearing area. In active lesions, exclamation mark hair may be seen around the margins. These are hair, which have a wide tip and narrow atrophic roots.

Nail changes may be present in 10% to 20% of cases in the form of geometric pitting (small, superficial and regularly distributed pits), geometric punctate leukonychia (multiple white spots in a grill pattern) and trachyonychia (sandpaper nails).


  • Reassurance should be given to patients with limited disease as spontaneous remission occurs in 80% of patients.
  • Intralesional corticosteroids, injection Kenacort or Tricort (Triamcinolone acetonide) 5 mg/mL, 0.05 to 0.10 mL at 1 cm to 2 cm intervals using a tuberculin syringe can be given once in three weeks.
  • Systemic steroids in general have been found useful in recent onset of disease rather than chronic alopecia areata, alopecia ophiasis and alopecia universalis.
  • Topical sensitizers like Dinitrochlorobenzene, Squaric Acid Dibutylester (SADBE) and Diphencyprone. Also, Anthralin application of 0.2% to 0.8% daily, tablet Cyclosporine 5 mg/kg/day and PUVA therapy are recommended.
  • Use of wigs - When treatments may not help the hair regrow in an attractive manner in alopecia areata or alopecia totalis or alopecia universalis, then camouflage techniques like hairpieces and hair additions may be a better option. Hairpieces could be in the form of wigs, demiwigs, toupees, cascades, and wiglets are useful.

To know more about alopecia, consult an alopecia areata specialist online -->

Frequently Asked Questions


What Are the Conditions That Can Mimic Alopecia Areata?

Conditions that may mimic alopecia areata are:
- Thyroid diseases.
- Diabetes.
- Iron deficiency anemia.
- Accidental pulling and twisting of hair.
- Lichen planus infection.


What Is the Advanced Type of Alopecia?

The most advanced type of alopecia is alopecia universalis. This type of alopecia occurs very rarely. This variant can cause complete hair loss in the body, including the hair of eyebrows and eyelashes.


What Foods Should Be Avoided in Alopecia?

The foods that should be avoided in alopecia are:
- Legumes.
- Grains.
- Dairy products. 
- Caffeine products.
- Alcohol and smoking.


How Long Does Alopecia Take To Develop?

Alopecia can develop rather quickly. A person may notice bald patches as early as a day or two. The person may experience extreme itching and burning sensations before hair loss. A typical case of alopecia can develop within weeks. The regrowth may take up to months.


Are Alopecia and Lupus Related?

Alopecia, in general, is related to other autoimmune disorders such as:
- Psoriasis.
- Rheumatoid arthritis. 
- Systemic lupus erythematosus (SLE).
- Diabetes.


What Is the Relation Between Lupus and Vitamin D?

It has been found that the deficiency of vitamin D is one of the causative factors for alopecia. The deficiency of this vitamin is the primary cause of alopecia. Vitamin D has been used as a supplement to treat alopecia. At times, topical application of vitamin D is also used.


Can Stress Cause Alopecia?

Yes, stress can act as a trigger for alopecia. Stress causes an increase in cortisol levels. That can lead to hair fall. Stress can cause the body’s immune system to attack the hair follicles leading to hair fall.


Is There Hope for Recovery From Alopecia Areata?

Yes, in most cases, alopecia is known to recover within a year of occurrence. Alopecia affects both men and women equally. Alopecia affects almost every person at some point in their lives. Only the gradient varies. Hence in many cases, it resolves spontaneously.


Are Alopecia and Alopecia Areata the Same?

Both alopecia and alopecia areata are disorders involving the hair follicles. Alopecia is hair loss due to the activity of excess androgens. Androgens make the scalp sensitive to testosterone, and hence hair loss occurs. Alopecia areata, on the other hand, is an autoimmune condition.


Can Alopecia Areata Occur After COVID-19 Recovery?

Alopecia areata can be a manifestation of COVID-19. It can be one of the dermatological complications of COVID-19. Alopecia mostly occurs two to three months after recovery from COVID-19. However, this is not scientifically proven yet.


Why Is My Alopecia Getting Worse?

Alopecia may worsen over time. This is mainly related to stress levels. It has been observed Alopecia worsens with increased stress levels. Both chronic and acute stress can cause it. This type of hair fall is associated with elevated cortisol levels. 

Last reviewed at:
20 Oct 2022  -  2 min read




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