Patchy hair loss: Symptoms, causes and treatment of alopecia areata

We all shed some hair every day—around 100 strands, which is totally normal. But let us be real, managing your hair can sometimes feel like a full-time job. From styling to preventing damage, it is easy to get stressed about it all. And here is the kicker—stress can actually lead to more hair loss, creating a vicious cycle. While daily shedding is part of the natural hair cycle, noticing patchy hair loss could be a sign of something else, like alopecia areata. This condition happens when your immune system mistakenly attacks your hair follicles, causing hair to fall out in small, round patches. It is a condition that can be tricky, but knowing more about it can help you manage and seek the right treatment.

What causes alopecia areata?

Alopecia areata is an autoimmune condition where the immune system mistakenly attacks hair follicles, leading to hair loss. In this condition, white blood cells target hair follicle cells as if they were foreign invaders like bacteria or viruses, causing hair to fall out and stopping growth. This often results in round, smooth patches of baldness, which can range from small, localized spots to complete hair loss and baldness in severe cases. The exact cause remains unclear but here are some common causes of alopecia areata:

1. Family history (heredity)

While scientists are unsure why these changes occur, genetics play a significant role in developing this condition. It is more likely to affect individuals with a family history of the disease, as per the National Institute of Arthritis and Musculoskeletal and Skin Diseases. About 20 percent of people with alopecia areata have a relative who also suffers from the disease. Despite this, the exact genetic triggers remain unclear.

2. Hormonal changes and medical conditions

Hormonal fluctuations, such as those that occur during pregnancy, childbirth, menopause, or due to thyroid problems, can play a role in triggering hair loss. Additionally, a 2018 review published in Clinical Reviews in Allergy and Immunology highlighted the connection between alopecia areata and other autoimmune conditions, like thyroid disease and vitiligo, suggesting that these conditions may share underlying causes that disrupt immune function.

3. Excessive stress

Excessive stress is another contributing factor that has been noted in some cases of alopecia areata. While stress alone is not a definitive cause, it can exacerbate the immune response and trigger or worsen hair loss.

4. Medications and supplements

Certain medications and supplements, including chemotherapy drugs, can cause hair loss, including alopecia areata. Radiation therapy, particularly to the head, may also result in hair loss due to damage to the hair follicles.

5. Hairstyles and hair treatments

Certain hairstyles and hair treatments, especially those that put excessive strain on hair follicles, can also contribute to the development of alopecia areata. Tight hairstyles such as ponytails or braids may increase the risk, while harsh treatments like bleaching or chemical perming can damage hair and lead to thinning or hair loss.

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6. Vitamin and mineral deficiencies

Nutritional deficiencies in vitamins and minerals such as vitamin D, B3, zinc, iron, biotin, and amino acids may contribute to the development of alopecia areata, reveals Dermatology Practical and Conceptual. A lack of these essential nutrients can impair the growth and hair follicle function, increasing the likelihood of hair loss in susceptible individuals.

While the exact cause of alopecia areata is not fully understood, it is clear that a combination of these factors contributes to this patchy hair loss condition.

Symptoms of alopecia areata

Here are common symptoms of this condition you should know:

• Patchy hair loss: Alopecia areata primarily causes patchy hair loss, affecting areas like the scalp, face, eyebrows, eyelashes, and body hair. The hair typically falls out in coin-sized patches, with the scalp being the most common area.
• Nail pitting: In addition to hair loss, alopecia areata can also impact nails. Changes such as thin, split nails, loss of shine, and rough texture can sometimes be the first signs of the condition.

Hair loss can occur suddenly, either within a few days or weeks. While the patches usually do not cause other symptoms, in rare cases, they may even lead to itching (pruritus), colour changes (red, purple, brown, or gray), and visible mouth-like openings in hair follicles (follicular ostia). Other signs may include black dots (hair shafts visible in the follicular ostia), exclamation point hairs (short hairs thicker at the top and narrower at the scalp), or the growth of white hairs.

How to diagnose alopecia areata?

Diagnosing alopecia areata usually starts with a visit to your healthcare provider, who will begin by doing a physical exam. They will ask about when you first noticed your hair loss and whether anyone in your family has had alopecia areata or any autoimmune conditions. They may also check your nails, as changes in them can be a sign of alopecia areata. If your provider needs more information to make a diagnosis, they might take additional steps. This could include:

• Looking at your scalp to rule out infections
• Taking a small hair sample to analyze in a lab
• Performing a scalp biopsy to check for any skin diseases
• In some cases, blood tests may also be done to check for other health issues that could be related to the hair loss

Treatment for alopecia areata

While there is no cure for alopecia areata, there are various treatments that can help slow down hair loss or encourage hair regrowth. However, treatment is not always successful, and some people may still experience hair loss despite trying different options.

• Topical treatments are commonly used to help with hair regrowth. Corticosteroid creams can reduce inflammation around hair follicles, while minoxidil may help stimulate hair growth.
• Topical immunotherapy is another option, where chemicals are applied to the scalp to trigger an immune response that encourages hair regrowth.
  For infections, steroid injections are often used for mild cases. A healthcare provider injects a steroid into the bald areas. The treatment has to be repeated every 1–2 months. However, this treatment does not stop future hair loss.
• Oral treatments include cortisone tablets for widespread alopecia, though they can have side effects. Immunosuppressants like methotrexate or cyclosporine may also be used to reduce immune system activity.
• Laser and light therapy helps promote hair regrowth by using specific light wavelengths or lasers to stimulate the hair follicles. Both are considered safe and effective.
• Some people explore natural treatments such as acupuncture, aromatherapy, vitamins (like zinc and biotin), essential oils (coconut, tea tree, castor), and even onion juice. Dietary changes may also help improve the condition.

Make sure if you notice any symptoms of alopecia areata, check with your doctor immediately.