What Is Alopecia Areata?Sudden Round Bald Patches

Your hairdresser noticed it first. A smooth, round patch the size of a coin behind your ear. You hadn’t felt a thing. A week later there’s another, smaller, near the crown. You’re not shedding like you do in the shower. This is a patch of nothing, with clean edges, and you keep touching it.

What it looks like

The NIAMS¹ describes a sudden loss of round or oval patches of hair on the scalp or other body areas, sometimes with short broken hairs or “exclamation point” hairs around the edges, and nail pitting in more extensive cases. The AAD² says it typically begins with a round or oval bald patch on the scalp or beard, which may be small and hidden or noticeable.

Who gets it

The AAD² says it usually begins in children and young adults but can start at any age, in all skin tones and genders. The NIAMS¹ says most people develop it in their teens, twenties or thirties, and that people with a family history or autoimmune conditions such as psoriasis or thyroid disease face higher risk. See psoriasis and thinning hair.

What causes it

The NIAMS¹ says scientists believe both genetic and environmental factors play a role, and that researchers don’t fully understand the mechanism. This isn’t the shedding of telogen effluvium, or the pulling of tight hairstyles.

Treatment and regrowth

The NIAMS¹ says there is no cure, but treatments help hair grow back more quickly. Recovery varies unpredictably, with full regrowth in some people and not in others, and hair tends to regrow better when loss is less extensive and starts later in life. The AAD² says that with treatment, some regrowth may appear in 6 weeks, but it takes months for full regrowth, and that newer treatments are regrowing hair for people who weren’t helped by past ones. A board-certified dermatologist can tell you if you have this type of hair loss and what may help.

The NHS³ lists steroid injections and immunotherapy among treatments for patchy hair loss. Ask a dermatologist which fit your case.

When it hurts emotionally

The NHS³ says losing hair can be upsetting, and that for many people hair is an important part of who they are. It says a GP can help arrange counselling, and suggests support groups and online forums.

The play

Try this: a patch map

Take a photo of each patch in daylight with a ruler or coin next to it, with the date. Re-photograph every two weeks.

Write down any other symptoms: nail changes, thyroid symptoms, a recent illness or stress.

Bring the photos to a dermatologist. Ask what type of hair loss it is and what treatment makes sense, and about support groups.

When to get checked

The AAD² says to see a board-certified dermatologist to find out whether it’s this type of hair loss and what may help.

Book an appointment if any of these fit:

• You’ve noticed a round or oval bald patch, or several
• Hair loss is sudden or spreading
• Your nails have pits alongside hair loss
• You have a thyroid condition or other autoimmune disease and notice patchy loss
• Hair loss is affecting your mood or confidence

An unpredictable condition is easier to handle with a dermatologist on your side and people who understand.