Skin and Beauty

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 Aug 09, 2019   -  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 -->

Last reviewed at:
09 Aug 2019  -  2 min read


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