Q: My teenage niece developed a bald patch above her ear and her dermatologist told her it was alopecia areata. What is that and what is her prognosis?

A: Alopecia areata is a condition characterized by the sudden appearance of smooth round patches of hair loss. It is believed to be an autoimmune disorder in which the immune system attacks hair follicle cells. More than 6.6 million people in the United States and 147 million worldwide have or will develop alopecia areata at some point in their lives.

It can affect men or women of any age, although a first episode of alopecia areata typically occurs before age 30. The hair loss may occur as a single, self-limiting event or may recur at varying intervals over many years. Although alopecia areata typically presents as small, round patches of baldness on the scalp, any other hair-growing region can be affected.


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Researchers don't know what triggers the immune system to attack hair follicles, so the exact cause of this condition is unknown. Alopecia areata most frequently occurs in people who have a family history of other autoimmune diseases, such as Type 1 diabetes or rheumatoid arthritis. This leads some scientists to suspect that genetics may contribute to the development of this condition. Some also suspect environmental factors are needed to trigger alopecia areata in those who are genetically predisposed to the disease.

The main goals of treatment are to block the immune system attack and/or stimulate the regrowth of hair. Conventional treatments for alopecia areata include steroid injections under the skin surface at the sites of hair loss, topical medications applied to the affected area and ultraviolet light therapy. Several types of topical medications may be prescribed, including steroids, hair-growth stimulants (minoxidil) and anthralin (a synthetic tar-like substance). Steroid injections are currently considered the most effective approach for small patches of hair loss. This treatment can be repeated every four to six weeks and stopped once regrowth is achieved.

Please reassure your niece that the overall prognosis for recovery is good. Most people with only a few small patches of hair loss get full regrowth within a year. In some cases, alopecia areata may persist for several years; rarely hair growth never recovers. Approximately 10 percent of patients progress to full-head or full-body hair loss. The National Alopecia Areata Foundation (NAAF) has excellent resources to help patients look and feel better. Alopecia areata can be emotionally challenging. NAAF also has support groups and online message boards to help people connect with others who have the condition.

Written by volunteers from the Grillo Center which offers free, confidential research to assist in health understanding and decisions. To use this service, contact us at grillocenter.org, 720-854-7293 or 4715 Arapahoe Ave., Boulder. No research or assistance should be interpreted as medical advice. We encourage informed consultation with a health practitioner.