Alopecia areata

Also called Hair loss, Alopecia totalis, Alopecia universalis

The immune system attacking hair follicles. Physically harmless, and it can end careers and friendships.

What it is

Alopecia areata is an autoimmune condition in which the immune system attacks hair follicles, causing hair to fall out in patches. It affects around 2% of people at some point.

It can be a single patch that regrows within a year, or it can progress to alopecia totalis, losing all scalp hair, or alopecia universalis, losing all body hair including eyebrows and eyelashes.

There is no physical illness attached to it. That is precisely why it is trivialised, and why the psychological impact is so poorly served. Studies find rates of depression and anxiety comparable with conditions that cause serious physical symptoms.

Losing eyebrows and eyelashes affects appearance more than most people expect, and eyelashes have a protective function that is genuinely missed.

Signs you might notice

Round or oval patches of complete hair loss, with smooth skin and no scarring.

Exclamation mark hairs at the edges of a patch, short and narrower at the base.

Nail changes: pitting or ridging, in a proportion of people.

Rapid onset, sometimes within days.

Regrowth that is initially white or fine, which is normal.

Scarring, redness or scaling suggests a different diagnosis and needs assessment.

How it can affect day-to-day life

The unpredictability is the hardest part. Hair may regrow and fall out again, and there is no reliable way to know.

Wigs are available on the NHS in some circumstances, and the criteria and quality vary considerably by area. Many people pay privately for something they can bear to wear.

Children face particular difficulty at school, and schools need to be proactive rather than reactive about bullying.

Eyelash loss causes dust and grit in the eyes, which is a real practical problem nobody warns about.

Newer treatments, JAK inhibitors, have shown substantial regrowth in trials for severe alopecia areata and access on the NHS is developing.

Supporting someone well

Take it seriously. Do not say it is only hair.

Ask about NHS wig provision, and about the quality options available locally.

Protect the scalp from sun and cold, and use glasses or sunglasses to protect eyes without lashes.

Ask about treatment: topical and injected steroids for limited patches, and about newer systemic options for extensive disease.

Get psychological support early rather than after months of distress.

For a child, work with the school on a plan before problems arise.

Check thyroid function, since autoimmune conditions cluster.

Where to get help

A GP can treat limited patches and refer to dermatology.

Alopecia UK provide support groups and information on treatments and wigs.

Changing Faces support people with visible differences.