Hair loss conditions Affects men and women
Alopecia areata: patchy hair loss and where to get help
Alopecia areata is an autoimmune condition in which the immune system attacks hair follicles, usually causing smooth, round bald patches that appear suddenly. Hair often regrows on its own, especially when only small areas are affected. WMG Meds does not treat alopecia areata; your GP and a dermatologist can, and the NHS now funds a tablet treatment for severe cases.
What is alopecia areata?
The British Association of Dermatologists (BAD) describes alopecia areata as a common, non-scarring type of hair loss that can happen at any age. Non-scarring means the hair roots are not permanently lost, so the hair can potentially grow back. It usually causes small, coin-sized, round bald patches on the scalp, but it can also affect the beard, eyebrows, eyelashes and body.
NICE CKS estimates that around 2% of people develop it at some point in their life, and that men and women are affected equally. In some people larger areas are affected. Losing all the scalp hair is called alopecia totalis, and losing all hair on the scalp, face and body is called alopecia universalis.
It happens because the immune system mistakenly attacks the hair follicle, stopping it from growing hair. Why this starts is not fully understood. It is linked with other autoimmune conditions, such as thyroid disease, vitiligo and type 1 diabetes, and with eczema, hay fever and asthma. It is not contagious and is not connected to food or diet.
It can be hard to live with. The BAD notes that people with alopecia areata have higher rates of depression and anxiety, and encourages talking about the emotional impact with your doctor as well as the hair loss itself.
Signs to look for
- One or more smooth, round bald patches that appear suddenly
- Patches that are not red, inflamed or scaly
- Short, tapered hairs at the edge of a patch, called exclamation mark hairs
- Sometimes itching, burning or tingling before or after the hair falls
- Loss of eyebrows, eyelashes or beard hair
- Small pits in the nails, like the dimples on a thimble
What causes it
The immune system
Immune cells attack the hair follicle and switch off hair growth. The follicle is not destroyed, which is why regrowth is possible.
Genes
There is a genetic tendency, but the BAD says only about 20% of people with alopecia areata have a family history of it.
Linked conditions
It is associated with thyroid disease, vitiligo, type 1 diabetes and atopic conditions such as eczema, hay fever and asthma.
Possible triggers
Previous infections and stress have been suggested, but the BAD says the link may be coincidental, as no trigger is found in many people.
How it is diagnosed
Alopecia areata is normally diagnosed by a doctor looking at the patches, and most people do not need any tests to confirm it. NICE CKS advises GPs to examine the skin for signs of scarring or inflammation, which would suggest a different diagnosis such as scarring alopecia. If the diagnosis is uncertain, a dermatologist may take a scalp biopsy.
Because alopecia areata is linked with other autoimmune conditions, your doctor may suggest further tests if you have other symptoms, such as signs of a thyroid problem. WMG Health's page on sudden hair loss in patches explains which blood tests are relevant.
NICE CKS advises referral to a dermatologist if the diagnosis is uncertain, or if you would like treatment that needs specialist input.
Treatment options
Every option below has trade-offs, and choosing not to treat is a reasonable decision too. Medicines are only prescribed after a doctor has reviewed your history and confirmed they are suitable for you.
What to expect
There is currently no cure, and treatments aim to help regrowth rather than change the overall course of the condition. The BAD says that, depending on how much hair is lost, there is a good chance that complete regrowth will happen within a year without treatment for 4 out of 5 people. Further episodes are common.
The outlook is less certain when more hair is affected. The BAD says those who lose more than half their hair at the start, or have complete hair loss at any stage, have only about a 1 in 10 chance of full recovery. Regrowth is also less likely in young children, in people with a family history of alopecia areata or other autoimmune conditions, when the hairline at the back of the scalp is affected, and when the nails are involved.
When hair does regrow, it often starts in the centre of the patch as fine white hairs that thicken and usually regain their colour over time.
When to see a doctor promptly
See your GP soon, rather than waiting or self-treating, if you notice any of these:
- Patches that are spreading quickly, or several new patches at once
- Loss of eyebrows or eyelashes, or sore, dry eyes after losing eyelashes
- Patches that are red, scaly or painful, which may point to a different condition
- A child with bald patches, or changes in a child's mood or behaviour linked to hair loss
- Feeling low, anxious or withdrawn because of your hair
Where to get help
WMG Meds does not treat alopecia areata with medication. It is an autoimmune condition that needs a GP and, often, a dermatologist, and the product information for licensed minoxidil states it is not intended for hair loss that is sudden or patchy.
The right first step is your GP, who can confirm the diagnosis, offer a trial of steroid treatment, and refer you to a dermatologist if you want specialist options, including ritlecitinib on the NHS for severe cases. WMG Health's page on sudden hair loss in patches explains which tests are relevant. For support, the charity Alopecia UK (alopecia.org.uk) is a good place to start.
If, separately, you also have gradual thinning on top or a receding hairline, our assessment can look at that pattern hair loss (see female pattern hair loss and male pattern hair loss). Please mention your alopecia areata so the doctor has the full picture. See is hair loss treatment available on the NHS for how NHS care works.
Frequently asked questions
Will my hair grow back?
Often, yes. The BAD says that, depending on the extent of hair loss, 4 out of 5 people have complete regrowth within a year without treatment, though further episodes are common. With more than half the hair lost at the start, the chance of full recovery falls to about 1 in 10.
Is alopecia areata caused by stress?
Not clearly. The BAD says infections and stress have been suggested as triggers, but the link may be coincidental, and no trigger can be found in many people. It is an autoimmune condition, and it is not caused by anything you ate or did.
Is ritlecitinib available on the NHS?
Yes, for severe cases. NICE recommended ritlecitinib in March 2024 (TA958) for severe alopecia areata in people aged 12 and over. It is prescribed by specialists, so you would need a dermatology referral. Baricitinib, another tablet, is licensed but was not recommended for NHS use (TA926).
Can minoxidil help alopecia areata?
The BAD says there is limited evidence for minoxidil used on its own, although it can sometimes help regrowth alongside other treatments, and it cannot be used on eyebrows or eyelashes. The licensed product information says minoxidil is not intended for sudden or patchy hair loss. WMG Meds does not prescribe it for alopecia areata.
Can I get a wig on the NHS?
You may be able to. The BAD says wigs can be obtained through the NHS on a consultant's prescription, usually with a contribution to the cost in England, so a dermatology referral may be needed. Alopecia UK and the BAD have published a charter calling for at least two acrylic wigs a year for people who need them.
Is alopecia areata contagious?
No. The BAD confirms it cannot spread to other people, and it has no connection to food or diet.
Sources
- British Association of Dermatologists: Alopecia areata, patient leaflet (April 2024)
- NICE CKS: Alopecia areata
- NICE TA958: Ritlecitinib for treating severe alopecia areata in people 12 years and over (March 2024)
- NICE TA926: Baricitinib for treating severe alopecia areata (October 2023)
- Alopecia UK
Facts checked against these sources on 4 October 2026. This page is general information, not a diagnosis. Read our editorial policy.