Alopecia Areata: What It Is, Why It Happens, and When to Seek Help

Alopecia areata (الثعلبة) is an autoimmune condition that causes hair to fall out in smooth, usually round or oval patches, most often on the scalp. It is not an infection, is not contagious, and has nothing to do with poor hygiene. It does not scar the skin, so the hair follicles remain alive and capable of producing hair again.

What exactly is alopecia areata?

Normally, the immune system protects the body from germs. In alopecia areata, the immune system mistakenly attacks the hair follicles themselves, so hair growth stops in the affected area and the hair sheds. The most common picture is one or more well-defined, smooth patches of normal-looking skin, usually without scaling or visible inflammation.

Alopecia areata can affect:

• The scalp (the most common site)
• The beard in men
• The eyebrows and eyelashes
• Body hair anywhere

Less common but more extensive forms exist: loss of all scalp hair, called alopecia totalis (الثعلبة الكلية), and loss of all body hair, called alopecia universalis (الثعلبة الشاملة). Some people also develop nail changes, such as tiny surface pits (nail pitting) or a rough nail texture.

What causes alopecia areata? Is it contagious?

The core cause is an autoimmune malfunction — the immune system treating hair follicles as if they were foreign. Genetic predisposition is thought to play a role: the condition is more likely in people with affected relatives. Alopecia areata can also cluster with other autoimmune or allergic conditions in the same person or family, such as thyroid disease, vitiligo, or atopic dermatitis (eczema).

For clarity:

• It is not contagious: it cannot spread by touch, shared combs or towels, or close contact.
• It is not a hygiene problem: it has nothing to do with how often you wash your hair or which shampoo you use.
• It is not the patient's fault: no behavior of yours brought it on.

What is the course of alopecia areata? Does the hair come back?

The course is unpredictable. In many cases, especially with a single patch or a few small patches, hair regrows within months without intervention; the new hair may initially be fine or white before gradually returning to normal. New patches can also appear, one patch may heal while another develops, or the condition may return after a period of improvement (relapse). Smaller areas of involvement are generally more likely to regrow, while extensive forms such as alopecia totalis and universalis are more difficult to improve. No one can predict the course for an individual patient.

Alopecia areata differs from other types of hair loss. Diffuse shedding across the whole scalp after a fever or illness — such as hair loss after COVID-19 — is called telogen effluvium and has a different cause and context.

The psychological impact of alopecia areata

Sudden hair loss, especially from the eyebrows or eyelashes or in visible patches, can cause anxiety, distress, and social withdrawal in adults and children. Patients can discuss this impact with their doctor or seek psychological support when needed.

What does research say about alopecia areata in Saudi Arabia?

A prospective multicenter study published in the International Journal of Dermatology in 2022 involved 68 patients with severe alopecia areata across three medical centers in Riyadh. It examined a class of medicines known as JAK inhibitors (Janus kinase inhibitors). The study is not a treatment recommendation or a promise of an outcome; the treating doctor evaluates each option according to the individual patient's condition.

When should you see a doctor?

See a dermatologist if you notice:

• A new bare patch on the scalp, in the beard, or anywhere else
• Patches that are spreading or appearing rapidly
• Nail changes such as pitting or roughness
• Loss of eyebrow or eyelash hair
• Scaling, redness, or itching of the scalp — some other conditions, such as psoriasis or fungal infections, can resemble alopecia areata and need an accurate diagnosis
• Clear emotional distress about your hair — that alone is a valid reason to visit

What happens at the dermatology clinic?

Diagnosis is mostly clinical: the doctor examines the patches, scalp, and nails, and may use dermoscopy (a skin-surface microscope) to look for signs characteristic of alopecia areata. A skin biopsy or blood tests are only occasionally needed, mainly to check for associated conditions. Multiple treatment and follow-up options exist, and they differ according to the patient's age and the extent and duration of the condition — the doctor determines what is appropriate for each case individually. In all cases, regular follow-up and psychological support remain an important part of the care plan.

Source: a study published in the International Journal of Dermatology, 2022 — DOI: 10.1111/ijd.15917

Frequently asked questions

Is alopecia areata contagious?

No, alopecia areata is not contagious at all. It is an autoimmune condition, not an infection, and it cannot spread by touch, sharing combs or towels, or everyday contact.

Does hair grow back with alopecia areata?

In many cases hair regrows within months, especially when there is a single patch or a few small ones. The course is unpredictable, however, and relapse can occur — so the outcome cannot be predicted for any individual, and follow-up with a dermatologist is key.

What causes alopecia areata? Is it a vitamin deficiency or poor hygiene?

The core cause is autoimmune — the immune system mistakenly attacks the hair follicles, with a role for genetic predisposition. It is not caused by poor hygiene, and a vitamin deficiency alone does not explain it; a doctor evaluates any contributing factors.

Can children get alopecia areata?

Yes, alopecia areata can appear at any age, including in children, and many cases begin early in life. If you notice a bare patch on a child's scalp, a dermatologist visit for accurate diagnosis is recommended.

What is the difference between alopecia areata and telogen effluvium?

Alopecia areata causes well-defined smooth bare patches, while telogen effluvium is diffuse shedding across the whole scalp, usually after fever, illness, or major stress, and is typically temporary. Telling them apart requires a clinical examination.

Related reading

• hair loss after COVID-19
• atopic dermatitis (eczema)