Alopecia Areata

Alopecia areata is a condition in which the body's own immune system mistakenly attacks the hair follicles and stops them from producing hair. The result is a sudden, smooth, round or oval bald patch, most often on the scalp but also possible in the beard, moustache, eyebrows and eyelashes. The patch usually appears over a few days to a few weeks and is often noticed first by a barber, a family member or in a photograph. The skin inside the patch looks normal and smooth, without scarring, without wounds and usually without pain. This is an important point, because the hair follicle is not destroyed. It is switched off rather than lost, which is why hair can grow back even after months.

Alopecia areata is common enough that most dermatologists see it every week, and it can begin at any age, including in children. It is not caused by dirt, by shampoo, by oil, by an infection, or by anything you did wrong, and it cannot be passed from one person to another. In many Indian families a patch of this kind is blamed on nazar or on some past event, and the person is treated with home applications, temple remedies or whatever a chemist suggests before a doctor is consulted. That delay matters, because treatment is generally easier and more successful when it is started while the disease is still active and limited to a small area. The course is unpredictable. A single small patch may regrow on its own within several months, while in other people new patches keep appearing or the older ones widen. Because it is unpredictable, it needs assessment rather than guesswork, and it also deserves to be taken seriously as something that affects confidence, sleep and social life, especially in young people.

Diagnosis & Treatment

The first step is to confirm the diagnosis, because more than one condition can cause a bald patch. Fungal infection of the scalp, which is common in children, causes scaling and broken hairs. Hair pulling habits leave irregular patches with hairs of different lengths. Some rarer conditions cause scarring, where the follicle openings disappear and hair cannot return. The doctor will examine the shape and edges of the patch, the state of the skin surface, the hairs at the border, the nails, and other hair-bearing areas such as the beard and eyebrows, usually with a magnified examination of the scalp. Blood tests are often advised to check thyroid function, haemoglobin and vitamin levels, and to look for associated autoimmune conditions. A small skin sample is needed only occasionally, when the picture is unclear.

Treatment is chosen according to age, how many patches there are, how much of the scalp is involved and whether the disease is still spreading. For limited patches, topical therapy applied to the affected area is usually the starting point, and in some cases medicine given directly into the patch in the clinic is advised. For more widespread or rapidly spreading disease, oral medication under supervision may be considered, and newer targeted prescription medicines are now available for severe disease in adults and older adolescents, though these need careful selection, counselling and monitoring and are not suitable for everyone. Children are treated more conservatively. Regrowth in alopecia areata is slow and follows the natural speed of hair growth, so a treatment is usually continued for about three to six months before deciding whether it is working. New hair often comes in fine, soft and white or grey at first, and thickens and regains colour over the following months. That white regrowth is a good sign, not a failure.

What you should expect is honest information rather than a promise. Many people with one or two patches regrow their hair, but relapse at the same or a different site is possible at any time in the future, and there is no treatment that can guarantee this will never return. Extensive disease, disease that starts in early childhood and loss of eyebrows and eyelashes are generally harder to treat. The most damaging mistakes are self-medicating with strong steroid creams bought over the counter, especially on the face and beard where they thin the skin and cause lasting redness and visible vessels, applying garlic, lime, kerosene or other irritating substances that can burn the skin, and stopping treatment abruptly when it seems to be working. Do not hide the problem until it is extensive. Come early, use only what has been prescribed for you, keep review appointments so the plan can be changed if there is no response, and tell your doctor if you feel low or anxious about the hair loss, because that part of the illness is real and deserves support too.