Patchy Hair Loss with Autoimmune Roots

Alopecia Areata is an autoimmune condition in which the immune system mistakenly targets hair follicles, leading to sudden, localized hair loss. It often presents as round or oval bald patches on the scalp or body. Although the condition is not contagious or life-threatening, its unpredictable course can cause significant emotional distress.

What Is Alopecia Areata?

This disorder arises when hair follicles enter a prolonged resting phase due to immune-related inflammation. While the exact cause is unknown, genetic predisposition and environmental triggers—such as stress or viral infections—may play a role. In many cases, hair regrowth occurs spontaneously, but recurrence is common.

Common Patterns of Hair Loss

Alopecia Areata can present in several clinical forms:

• Patchy (Classic) Type: One or more round bald spots, typically on the scalp.
• Alopecia Totalis: Complete loss of scalp hair.
• Alopecia Universalis: Total loss of hair across the scalp and body.
• Ophiasis Pattern: Hair loss in a band-like distribution around the sides and lower back of the scalp.
• Diffuse Type: Generalized thinning without distinct bald patches.

Possible Contributing Factors

Although the condition is primarily autoimmune in nature, several internal and external factors may contribute:

• Family history of alopecia or other autoimmune diseases
• Emotional or physical stress
• Viral illnesses
• Hormonal changes or metabolic imbalance
• Skin trauma or prolonged inflammation

When Is Treatment Needed?

Treatment is considered when:

When Is Treatment Needed?

Treatment is considered when:

• The hair loss is extensive or rapidly progressing
• There is significant psychological impact
• Regrowth has not occurred after several months
• Involvement spreads to eyebrows, eyelashes, or beard area
• Dermoscopy confirms follicular dropout: If dermoscopic examination reveals loss of hair follicles, in-office corticosteroid injections may be initiated promptly
• When diagnosis is uncertain: In cases where the clinical presentation is atypical or other scalp disorders are suspected, a scalp biopsy may assist in confirming the diagnosis

Treatment Options

There is no definitive cure, but several treatments aim to reduce inflammation and stimulate hair regrowth.

1. Topical Treatments

• Topical Corticosteroids: Help suppress local immune response and are often first-line for children or mild cases.
• Minoxidil (5%): Stimulates hair follicles, often used in combination with other treatments.
• Topical Immunotherapy: Involves applying contact allergens to trigger a mild, targeted immune response that can help restart hair growth.

2. Intralesional Injections

• Corticosteroid Injections: Delivered directly into bald patches, often every 3–6 weeks; effective in localized cases.
• Platelet-Rich Plasma (PRP): Utilizes the patient’s own concentrated platelets to stimulate follicle activity and reduce inflammation.

3. Systemic Therapies

• Oral corticosteroids: May be used short-term in rapidly progressing or extensive cases.
• Immunomodulators or JAK inhibitors: Emerging options in more resistant or recurrent cases, typically under specialist care.

What to Expect During and After Treatment

• Session Time: 15–30 minutes depending on method
• Pain Level: Topical treatments are painless; injections may cause mild discomfort
• Side Effects: Temporary redness, thinning of skin (with steroids), or mild irritation
• Response Time: Regrowth often begins after 4–8 weeks, but multiple sessions may be needed
• Monitoring: Periodic assessment is crucial to track progress and adjust treatment

Aftercare and Lifestyle Recommendations

• Minimize physical or emotional stress when possible
• Protect the scalp from sun exposure or harsh styling products
• Use gentle, non-irritating hair and skin products
• Stay consistent with treatment schedules and follow-up visits
• For some patients, camouflage options (e.g., hair fibers or cosmetic tattooing) may offer temporary support

Key Points at a Glance

• Type: Autoimmune, non-scarring hair loss
• Onset: Sudden, patchy loss on scalp or body
• Duration: Variable; often recurrent or chronic
• Treatment Time: 15–30 min per session
• Regrowth: Often begins within weeks, may require multiple sessions
• Ideal For: Individuals with isolated or diffuse patchy hair loss
• Contraindications: Active infections, uncontrolled autoimmune disease, or certain medications without medical clearance

Every problem has a solution. Sometimes it’s just a matter of looking at it differently.”
— Edward de Bono, pioneer of lateral thinking