Circular or Patchy Hair Loss – Alopecia Areata

Cosmedica Team

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Alopecia Areata

Millions of people are affected by a condition that makes the hair fall out in circular patches. This is called Alopecia Areata.

It is usually sudden – one day everything is normal, then almost overnight the hair falls out and round small bald patches appear on the head.

Alopecia Areata is an autoimmune disease, meaning that the body’s immune system misidentifies a part of the body as an alien threat such as a virus. It is one of the most common types of hair loss, exceeded only in frequency by genetic hair loss.

The most characteristic symptom of alopecia are these circular bald patches because the immune system attacks the hair follicles in that area, which causes the hair to fall out.

The factors which cause people to develop Alopecia Areata have not yet been precisely clarified by doctors. In fact, to this day, this disease poses a great mystery to doctors.

The facts are that it is an autoimmune disease and the second most common cause of hair loss – after genetic hair loss, known as androgenetic alopecia.

Many people find that suffering from Alopecia Areata is a traumatising or shocking event because it is so sudden. Because the hair falls out in very clear circles, the hair loss can be very visible.

The causes and symptoms of circular hair loss

Alopecia areata is an autoimmune disease. Suddenly and without any recognisable cause, the body identifies the hair follicles, in which the hair roots are formed, as foreign bodies and begins to attack them accordingly.

This in turn leads to an inflammatory reaction in the affected area, because of which the hair falls out within a very short time.

What remains are the circular or oval hairless areas, typical of this disease. Broken hairs can be found at the edge of these.

In some cases, it is mainly the pigmented hairs which fall out and grey hairs remain. If someone has a lot of grey hairs, only these are left over, giving the impression that the person affected has prematurely gone grey.

To date, it has not been conclusively clarified what triggers Alopecia Areata. Like hereditary hair loss, some people with alopecia areata are suspected to be more prone to it than others. Often there is a family history of the condition. In about 25 % of cases, it also occurs in a family member or in close relatives.

In addition, people with trisomy 21 or with white spot disease (vitiligo) often suffer from circular hair loss. The symptoms also occur in connection with thyroid diseases such as Graves’ or Hashimoto’s disease. Persistent stress is also suspected of sometimes triggering alopecia areata.

Types and symptoms of Alopecia Areata

There are 5 different types of Alopecia Areata:

Alopecia multilobularis – bald spots appear in several places on the head
Alopecia unilocularis – the hair only falls out in one place on the head
Alopecia totalis – all hairs on the head fall out
Alopecia universalis – rather than patches of hair loss, all the hair on the body falls out
Alopecia ophiasis – the hair falls out like a crown around the neck and ears (this is a special and unusual form of the disease).

The good news is that in all forms of alopecia areata, once the episode is finished the patient is able to regrow hair.

However, the tricky thing about alopecia areata is that the disease usually occurs in episodes.

This means, for example, that the circular hair loss can reappear just as when the hair starts to grow again. Quite often, spotted or grooved nails appear as a side symptom.

Circular hair loss in women

Women are more often affected by alopecia areata than men. And women in particular often suffer enormously when their hair falls out all at once.

Flowing hair and dense hair is still considered a sign of femininity, even though there are more and more women who have made their bald head their trademark.

Otherwise, a wig can at least conceal it visually. If the hair does not grow back properly after the disease has been overcome, a hair transplant can be a solution.

Alopecia areata in men

In men, circular hair loss can also occur in the beard area. It can also affect the eyebrows, and (very rarely) it can be seen in body hair.

If it affects the beard, you can shave off your beard during an episode of alopecia areata. With the area around the affected circle also free of hair, it makes it almost invisible.

Especially in the case of Alopecia Areata multilobularis and Alopecia Areata unilocularis, wearing a head covering is recommended, at least as an interim solution.

If a man’s hair does not grow back properly after an episode, a hair transplant can also be the solution here.

What helps with circular hair loss?

Since the cause of the disease has not been conclusively clarified, there is no effective therapy yet which decisively guarantees hair regrowth.

In mild cases of alopecia areata, the hair grows back within three to six months. However, this self-healing can also take years.

The doctor, in this case a dermatologist, only treats the symptoms of the disease, for example with zinc tablets. Therapies with cortisone and prednisolone can also be effective. However, these are associated with enormous side effects, as the drugs suppress the immune system. This also leaves the patient vulnerable to other illnesses and medical conditions.

Meanwhile, great success has been achieved with topical immunotherapy. In this treatment, the scalp is sensitised with special allergens. The reaction triggered in this way is supposed to stimulate hair growth again.

In some cases, the immune reaction which leads to Alopecia Areata can be linked to prolonged and extreme stress. It can be that if the stress lessens, so does the immune reaction and with a bit of time, normal hair growth can resume.

However, it always depends on the specific case whether this therapy can be used. In addition, this treatment is only carried out in specialised medical practices or clinics.

In any case, it is advisable to consult a doctor if you suffer from Alopecia Areata.

Hair transplant for circular hair loss?

In principle, hair transplantation is possible for alopecia areata. This is particularly the case when the hair no longer grows back in its former density and bald patches remain.

However, it is very important that the Alopecia Areata is completely healed. Otherwise, there is a risk that the immune system will attack the freshly transplanted follicles and they will immediately fall out again.

A reputable hair doctor will examine the bald area closely to make sure that there is no risk of the transplanted hair follicles being attacked again by the immune system.

A good and reputable hair transplant clinic will never pressure you into a hair transplant. In cases of Alopecia Areata a hair transplant can have good results, but is only suitable in certain circumstances. In the wrong circumstances, it can do more harm than good.

If you have any further questions, please do not hesitate to contact us. The professional team of experts at Cosmedica Clinic will be happy to answer all your questions about hair transplantation for circular hair loss.

Click on the WhatsApp button to get a free consultation with Cosmedica Clinic’s award-winning and world-renowned surgeon Dr. Levent Acar.