The rate, extent and pattern of hair loss varies considerably. New patches of hair loss may occur at the same time that other areas are undergoing re-growth. Although the hair can grow back spontaneously at any time, it can fall out again, and the frequency of recurrent episodes cannot be predicted. The more extensive the hair loss and the longer the duration, the less likely it will grow back.

What other changes in my body should I expect?

Itching and tingling may be present prior to or concurrent with the development of the alopecia areata. Sometimes finger and toe nails may become distorted (e.g. finely pitted)--a condition that may also precede or coincide with the onset of alopecia areata, as well as persist even if the hair does grow back.

There are generally no other symptoms associated directly with alopecia. However, people with the condition may have a higher incidence of certain ailments, including asthma, atopic dermatitis, hay fever, thyroid disease and autoimmune disorders such as lupus, vertiligo and rheumatoid arthritis. Although a direct cause and effect relationship between these disorders and the development of alopecia areata has not been documented, the hair is less likely to grow back in the presence of asthma or atopic dermatitis. Moreover, the treatment of any of these associated conditions does not necessarily result in an arrest of the alopecia areata.

What are the psychological ramifications?

Although alopecia areata is medically benign, it can be psychologically devastating. The loss of hair--with its sudden onset and unpredictability of both its severity and recurrence--evokes not only cosmetic concerns, but also rouses up feelings of vulnerability, loss of self-esteem, loss of control, helplessness and alterations in self-image. In fact, a grief reaction often occurs.

Family, friends and even physicians may suggest to those with alopecia areata that their hair loss is brought on by stress, which may cause those affected to engage in self-blame. Further, people with alopecia areata are often "comforted" by family and friends that at least they do not have cancer, but only a benign cosmetic problem, thus inducing feelings of guilt for feeling so terrible. This often prevents those affected from verbalizing their feelings, which, in time, can lead to emotional isolation.

To respond to the emotional trauma evoked by alopecia areata, The National Alopecia Areata Foundation (NAAF) has established a network of more than 50 support groups throughout the country. Click here for a link to the National Alopecia Areata Foundation for more information.

Besides appearance, does hair serve any other purpose?

Body hair does serve valuable functions. For example, the loss of hair from the scalp subjects the body to heat loss and leaves the scalp unprotected from the sun and other elements; the loss of eyebrows and eyelashes leaves the eyes unprotected from dust, sweat and glare. The loss of nasal hair makes the nose and sinuses vulnerable to the invasion of foreign particles.

Who gets Alopecia areata?

Alopecia Areata affects about 2.5 million people (0.1 percent of the population) in the United States. It is estimated that 1 to 4 percent of all dermatology visits involve patients with the ailment. However, the exact incidence is unknown, since many mild cases and cases not involving the scalp are never brought to the attention of a physician.

Alopecia areata affects people of all ages, although it may occur more often in children and adolescents. About 60% of those with the condition develop it before the age of 20. Alopecia is genetic for about 10 - 20% of the people with the malady. People with alopecia tend to have a higher incidence of asthma and atopic dermatitis.

How can it be treated?

At present, there is no cure for alopecia areata, although it can go away by itself. There are treatments which are most effective in milder cases, but none are universally effective and it is not known how any of the drugs work.

Some of the drugs used to treat alopecia areata include:

Steroids - Can be administrated by injection below the skin (particularly effective when used in the eyebrow area), applying a cream topically or by mouth (can cause serious side effects).
Diphencyprone (DPCP), dinitrochlorobenzene (DNCB), squaric acid dibutylester (SADBE) and anthralin - All are agents, which when applied to the areas of hair loss, create a skin rash. It is speculated that this reaction diverts the attention of the immune system from acting on the hair to responding to the skin rash, thus allowing the hair to grow. Of these four agents, only anthralin is generally available in the U.S.
Psoralen with ultraviolet light A (PUVA) - More effective in people who experienced their first episode of alopecia areata after the age of 20. Requires travel to the physician's office two to three times a week. A major side of PUVA treatment is skin cancer.
Minoxidil - Can be prescribed alone or in combination with other drugs such as topical steriods or anthralin.
Immunosuppressants - These drugs, such as cyclosporine and isoprinosine, can have serious side effects and are therefore not used very often.

What are the best hair replacement options?

Full Wig
Hair Addition
Corrective Makeup and Permanent Makeup Tattooing

In instances of Alopecia Totalis where there are no eyelashes or eyebrows, makeup or can accomplish a remarkable transformation. Highly skilled experts achieve the illusion of eyelashes or eyebrows through the use of tattooing and corrective makeup.