Hair loss types: Alopecia areata signs and symptoms

What are the signs and symptoms of alopecia areata?

This disease causes sudden hair loss, which often begins as a round or oval, smooth balding patch that develops on the scalp or beard. However, hair loss can begin on any area of the body. Some people lose eyebrows, eyelashes, nostril hairs, or hair on their legs.

Aside from hair loss, people with alopecia areata may also notice:

• Changes to their nails

• Itching, tingling, or a burning sensation where hair loss will soon begin or has already occurred

• Irritated eyes if eyelashes or eyebrows are lost

The following alopecia areata photos show you the early signs, how this type of hair loss can progress, and some nail changes that can occur.

Round or oval, smooth bald patch on the scalp

This patch is often the first sign of alopecia areata. Where you have hair loss, you’ll see no signs of irritation like swelling or discoloration.

Hair loss on the beard

Hair loss may begin on the beard instead of the scalp. This hair loss may be patchy (A) or cause a well-defined bald spot (B).

Spotty hair loss (multiple patches)

If the hair loss continues, more patches of hair loss appear. The patches can be large (A) or a mixture of sizes (B).

Widespread hair loss

If the condition progresses, it can cause widespread hair loss, as shown here. Widespread hair loss is less common.

Loss of eyebrows

When alopecia areata causes loss of eyebrows, people usually develop patchy hair loss on both eyebrows. Some people lose most or all their eyebrows, as did this patient.

Loss of eyelashes

Loss of eyelashes usually develops on both eyes, causing some eyelashes on both the upper and lower eyelids to fall out.

Band of hair loss

Instead of developing one or more patches of hair loss, some people have a band or strip of bald skin on their scalp, known as ophiasis (oh-fee-ah-sis). This band usually appears at the back of the head and can extend to the temples (A).

Alopecia totalis

Alopecia areata can progress, causing loss of all hair on the scalp (B). The medical name for complete loss of hair on the scalp is alopecia totalis (AT). This patient developed AT after experiencing widespread hair loss (A). AT is more common in children and young adults but can occur at any age.

Nail changes

About 10% to 20% of people who have alopecia areata see changes to their nails. Tiny dents are the most common. You may also see red nails (A), ridges that run the length of the nails, nails that become so rough they feel like sandpaper, or brittle nails that split (B).

Alopecia universalis

While rare, some people lose all the hair on their body. The medical name for this condition is alopecia universalis. This boy’s hair loss began with a single patch of hair loss on his scalp.

Brittle and crumbling nails

People who lose all the hair on their scalp and body (alopecia universalis) often develop brittle, crumbling nails like those shown here. This can be painful.

Other signs that you may have alopecia areata include:

• Hair starts to regrow on its own where it fell out.

• Hair begins growing in a bald spot and starts falling out in another area.

• Hair loss occurs during a colder month of the year

Cold may be a trigger for alopecia areata. In one study, researchers noticed that people diagnosed with alopecia areata most often had hair loss in November, followed by October and January. Patients had the fewest flare-ups during May and August.

While anyone can develop alopecia areata, some people have a higher risk. To find out if you have an increased risk, go to: Alopecia areata: Causes.

Images
Image 1: Getty Images
Images 2,8,9: Used with permission of DermNet NZ.

Used with permission of the Journal of the American Academy of Dermatology:

• Images 3,4,5,11,13,14,15,16: J Am Acad Dermatol 2018;78:1-12.

• Image 7: J Am Acad Dermatol 2017;76:948-57.

• Image 12: J Am Acad Dermatol 2010;62:177-88.

• Image 18: J Am Acad Dermatol 2018;79:e9-e10.

Used with permission of JAAD Case Reports:

• Image 6: JAAD Case Reports 2022;22:85-8.

• Image 10: JAAD Case Reports 2022;29:43-5.

• Image 17: JAAD Case Reports 2020;6:257-259.

References
Jia WX, Mao QX, et al. “Patchy alopecia areata sparing gray hairs: A case series.” Postepy Dermatol Alergol. 2014 May;31(2):113-6.

Lipner SR, Scher RK. “Letter to the editor: Alopecia areata.” J Am Acad Dermatol 2018;79:e9-e10. Funding sources: None. Conflicts of interest: None disclosed.

Nguyen B, Hu JK, et al. “Eyebrow and eyelash alopecia: A clinical review.” Am J Clin Dermatol. 2023 Jan;24(1):55-67.

Otberg N, Shapiro J. “Alopecia areata.” In: Kang S, et al. Fitzpatrick’s Dermatology. (ninth edition) McGraw Hill Education, United States of America, 2019:1517-9.

Putterman E, Castelo-Soccio L. “Research Letters: Seasonal patterns in alopecia areata, totalis, and universalis.” J Am Acad Dermatol 2018;79:974-975. Funding sources: None. Conflicts of interest: None disclosed.

Strazzulla LC, Wang EHC, et al. “Alopecia areata: Disease characteristics, clinical evaluation, and new perspectives on pathogenesis.” J Am Acad Dermatol. 2018;78(1):1-12.

Written by:
Paula Ludmann, MS

Reviewed by:
Elizabeth M. Damstetter, MD, FAAD
Arturo Dominguez, MD, FAAD

Last updated: 8/30/23