GoodRx Guide
Alopecia Areata: Your GoodRx Guide
Comprehensive information for you or a loved one — including treatment options and discounts on popular medications.
Definition
Alopecia areata is a condition that causes you to lose patches of hair — usually round or oval spots on the scalp, but it can occur anywhere you have hair. The patches can be small and unnoticeable, or they can grow larger. Many people will eventually regrow the lost hair.
Alopecia areata affects up to 2% of people of all ages and genders, but the condition affects each person differently. Some people will have only one episode of hair loss and regrowth, whereas others will have several cycles of hair loss and regrowth over the course of their life.
Alopecia areata is not life-threatening, but for many people it can be life-altering. For people who want treatment, there are different medications that can work well and resources to help cope with hair loss.
Causes
We don’t know exactly what causes alopecia areata, but studies suggest that it’s an autoimmune condition. This condition causes certain cells in your immune system to attack hair follicles, which keeps them from growing normally.
Most people get alopecia areata during their teens and 20s. It’s uncommon for people over age 60 to get alopecia areata.
Like many autoimmune disorders, both genetics and environmental triggers, like stress, are to blame.
Up to 25% of people with alopecia areata have a family member with it. If one identical twin has alopecia areata, the other twin has about a 55% chance of getting it.
If alopecia areata runs in your family, you are more likely to get it. And you may be at increased risk of getting alopecia areata if you have another autoimmune disease, such as:
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Symptoms
Alopecia areata mainly affects the skin, but it can affect a person’s nails and mental well-being, too.
Skin changes
Alopecia areata begins as patches of sudden hair loss, usually on the scalp or beard (if you have one). Some spots don’t get bigger, while others may grow and cause hair loss over larger areas. Some people notice white hairs in the areas of hair loss. It can be common to have cycles of hair loss and regrowth over time, but it’s hard to predict how different people will be affected.
Most people with alopecia areata don’t have any other symptoms, but some may experience tingling or itching before the hair falls out.
There are different patterns of alopecia areata, which depend on how much hair is lost and where the hair loss is:
Patchy alopecia areata: This is the most common type, where patches of hair are lost all over the scalp. People with this type are the most likely to have hair regrowth.
Alopecia totalis: All scalp hair is lost.
Alopecia universalis: All scalp and body hair is lost.
Ophiasis: Hair loss is limited to the sides and lower back of the scalp.
Nail changes
About 65% of people with alopecia areata notice changes in the texture, shape, or length of some or all of their nails. These nail changes can improve on their own, but if not, there are treatments that may help (see treatment section, below).
Examples of nail changes include:
Pits (tiny dents) or ridges that go from the cuticle to the tip of the nail
Rough nails that feel like sandpaper
Brittle nails that split
Nails turning a reddish color
Related Health Conditions
Diagnosis
Your provider will examine the areas of hair loss and look for nail changes. They may use a handheld tool called a dermatoscope, which is a specialized magnifying glass, to see smaller broken hairs (called “exclamation mark” hairs) that are common in alopecia areata.
They will also ask you questions about your hair loss (like how long you’ve had it and whether it happened quickly), your medical history, and your family’s medical history. Your provider may also gently pull on your hair to see if any comes out, and examine your hair under a microscope. This can tell them about the health of your hair and give clues about why it’s coming out.
Usually, this is all that is needed to diagnose alopecia areata, but there are other conditions — like telogen effluvium — that can look like alopecia areata, so sometimes a skin biopsy is needed. A skin biopsy is a small procedure done in your provider’s office. Your skin will be numbed with a needle, and a small piece of skin (about the size of a pencil eraser) will be removed. You may get a stitch put in afterward to help the area heal. Your skin biopsy is sent to a lab where specially trained physicians will evaluate it under the microscope.
You may also need to get blood work to look for other causes of hair loss or to see whether you have other autoimmune conditions.
Treatments
There is no treatment to permanently reverse, or cure, alopecia areata. Most treatments can make hair regrow, and some can stop hair loss from spreading. But there’s always the chance that hair loss could happen again in the future.
Some people may choose not to get any treatment at all. For those who do, there are different options that work. Which treatment is best for you depends on your age, how much hair loss there is, and how much it bothers you. Sometimes, treatments are combined for better results.
You and your provider will decide which treatment approach works best for you, but there are some general guidelines that can help:
Children under the age of 10 start with creams, like steroids and minoxidil.
For people older than 10 who’ve lost less than 50% of their scalp hair, the first treatment is usually steroid shots, along with topical steroids and minoxidil for better results.
For people older than 10 who’ve lost more than 50% of their scalp hair, contact immunotherapy or JAK inhibitors plus steroid shots are usually a good starting point.
People with more severe hair loss, or hair loss that hasn’t responded to other treatments, may benefit from medications like methotrexate or cyclosporine.
The nail changes seen in alopecia areata can be hard to treat. Medications used to treat hair loss — like corticosteroid creams, injections, or pills — can be used for the nails, but not everyone improves.
Medications
Medications for alopecia areata include:
Topical treatments you apply to the skin, the most common type of treatment
Shots given into the skin where there is hair loss (intralesional)
Pills, which can treat the entire body (systemic treatment)
It’s common to need more than one course of treatment. If your hair regrows, you can usually stop taking medication and see what happens. If you start to get new areas of hair loss, then you may need to restart medication:
Baricitinib (Olumiant): This is the first FDA-approved pill to treat alopecia areata in adults. It’s a Janus kinase inhibitor (JAK inhibitor), a new class of medication that blocks the parts of the immune system that cause alopecia.
Corticosteroids: These medications lower inflammation and help damaged hair follicles recover faster. They usually come as a cream, such as clobetasol (Temovate), or as an injection (in your provider’s office). Steroids can also come in pill form (like prednisone) in some severe cases that don’t respond to other treatments.
Minoxidil (Rogaine): You apply this medication to areas of hair loss. It can help stimulate hair growth, but it doesn’t stop alopecia areata from spreading. It works best in combination with other treatments.
Calcineurin inhibitors: These medicated creams dampen the immune response. They don’t work as well as steroids to regrow hair, but they have fewer side effects. And you can use them on sensitive areas, like the face. Examples include tacrolimus (Protopic) and pimecrolimus (Elidel).
Bimatoprost (Latisse): This glaucoma medication can help regrow eyelashes.
Anthralin (Drithocreme): You put this leave-on medication on areas of hair loss before washing it off. It causes some skin irritation, which helps hair regrowth in some people.
Methotrexate (Trexall): This pill can treat many types of autoimmune diseases. In severe alopecia areata, it can block inflammation and help with hair regrowth. You need regular blood work when you’re taking methotrexate to make sure it’s not causing problems with your liver or blood count.
Cyclosporine (Neoral): This pill works by lowering the immune response. It can help hair regrow after severe hair loss. This medication also requires regular blood work.
Biologics: These newer medications have also been used to treat alopecia areata in some people, but there isn’t as much evidence for them yet. More studies are needed to see how effective they are and who may benefit from them.
Alternatives
Hair can regrow without treatment, but it’s hard to predict when that will happen. In general, the less hair loss you have, the more likely it is to regrow. Some studies have shown that up to 70% of people with small areas of alopecia will regrow their hair. People who have lost more than 50% of their scalp hair have only about an 8% chance of regrowth. No matter what, people who have regrowth can still lose hair again in the future.
Here are some factors that may make it less likely that your hair will regrow on its own:
A family history of autoimmune conditions
A personal history of asthma, allergies, or eczema
Severe hair loss and the ophiasis pattern
Symptoms that started in childhood
Nail changes
Having had hair loss for a long time
There are some other treatments that don’t involve taking pills or applying creams:
Contact immunotherapy: In this process, your provider puts a chemical solution, such as diphenylcyclopropenone (DPCP), onto areas of hair loss once a week in order to cause an allergic skin reaction. We don’t know exactly how it works, but the reaction helps your hair regrow.
Excimer laser: This small, handheld device emits a wavelength of ultraviolet-B light. It can be used to treat small areas of alopecia areata.
Concealing hair loss: Products such as hairpieces or semi-permanent hair additions, like extensions, can be used to hide hair loss. These can last up to 8 weeks.
Living
People who have alopecia areata often live with:
Low self-esteem
Shame
Social isolation
Poor sleep
Depression
The emotional impact of alopecia is especially significant in children and can have a knock-on effect on their school performance, relationships, and their families.
There’s also the day-to-day challenges of life without hair, such as:
Runny nose
Sneezing
Eye irritation
Sunburn
Difficulty participating in sports or other activities
Raising awareness of the condition and its unique challenges, as well as support groups and mentorship for people living with the condition and their families, can help make their journey through life easier.
Some good places to start for more information about alopecia areata:
Common concerns
No, unfortunately it’s not possible to prevent alopecia areata from coming back, even if you experience hair regrowth. So far, we don’t have a cure for alopecia areata.
Male-pattern baldness is also called androgenic alopecia. It actually affects people of all genders, and is the most common form of hair loss. This type of hair loss is mainly related to your genes and your age — it’s not an autoimmune condition like alopecia areata. In general, alopecia areata also looks different than androgenic alopecia. Males tend to lose hair at the temples and that continues toward the top of the head. In females, hair usually thins all over the scalp, but they don’t lose as much hair toward the front (at the hairline).
Most medications used for alopecia areata will be covered by insurance. You may have to try certain medications first before other ones are approved. Check with your provider and your individual plan to see what is available to you.
References
Alkhalifah, A., et al. (2010). Alopecia areata update: Part I. Clinical picture, histopathology, and pathogenesis. Journal of the American Academy of Dermatology.
Alkhalifah, A., et al. (2010). Alopecia areata update: Part II. Treatment. Journal of the Academy of Dermatology.
American Academy of Dermatology Association. (2021). Do you have hair loss or hair shedding?
American Academy of Dermatology Association. (2021). Hair loss types: Alopecia areata overview.
American Academy of Dermatology Association. (2021). Hair loss types: Alopecia areata signs and symptoms.
Darwin, E., et al. (2018). Alopecia areata: Review of epidemiology, clinical features, pathogenesis, and new treatment options. International Journal of Trichology.
Garcia-Melendo, C. (2021). Janus Kinase inhibitors in dermatology: Part 1 — General considerations and applications in vitiligo and alopecia areata.. ACTAS Dermo-Sifiliog.
Globe News Wire. (2021). Alopecia areata clinical trials report: Pipeline insight 2021 by delveinsight.
Hordinsky, M. K. (2018). Alopecia areata: The clinical situation. Journal of Investigative Dermatology Symposium Proceedings.
Hunt, N., et al. (2005). The psychological impact of alopecia. BMJ.
Juarez-Rendon, K. J., et al. (2017). Alopecia areata. Current situation and perspectives. Archivos Argentinos de Pediatría.
Lipner, S. R., et al. (2018). Alopecia areata. Journal of the American Academy of Dermatology.
McMichael, A. J. (2013). Excimer laser: A module of the alopecia areata common protocol. Journal of Investigative Dermatology Symposium Proceedings.
Meah, N., et al. (2020). The Alopecia Areata Consensus of Experts (ACE) study: Results of an international expert opinion on treatments for alopecia areata. Journal of the Academy of Dermatology.
National Alopecia Areata Foundation. (2021). Welcome to the Alopecia Areata Marketplace — An online shop featuring the latest products and accessories designed for people with partial or total hair loss.
National Alopecia Areata Foundation. (2021). What you need to know about alopecia areata.
Phillips, T. G., et al. (2017). Hair loss: Common causes and treatment. American Family Physician.
Spano, F., et al. (2015). Alopecia areata part 1: Pathogenesis, diagnosis, and prognosis. Canadian Family Physician.
Strazzulla, L. C., et al. (2018). Alopecia areata: An appraisal of new treatment approaches and overview of current therapies. Journal of the American Academy of Dermatology.
Strazzulla, L. C., et al. (2018). Alopecia areata: Disease characteristics, clinical evaluation, and new perspectives on pathogenesis. Journal of the American Academy of Dermatology.
Tosti, A., et al. (2006). Alopecia areata: A long term follow-up study of 1919 patients. Journal of the American Academy of Dermatology.
U.S. Food and Drug Administration. (2022). FDA approves first systemic treatment for alopecia areata.
