Alopecia areata – causes, varieties, treatment methods

Alopecia areata is a type of hair loss that occurs not only in adults but also in children. This condition can appear at any age, with the first symptoms often showing during adolescence or even childhood. In 60% of cases, alopecia areata is diagnosed before the age of 20. It is the most common cause of hair loss after androgenetic alopecia. The condition affects both men and women. Unlike androgenetic alopecia, hair transplantation is not an option for alopecia areata.

What is alopecia areata?

Alopecia areata is a dermatological disease that can occur at any age. The problem mainly affects the scalp, although other hair-bearing areas of the body can also be involved – including cases of eyebrow and eyelash alopecia. Skin lesions often appear suddenly, and the course of the disease varies from patient to patient.

Alopecia areata may present as a single patch of baldness that persists, or it may take the form of multiple recurring patches. Hair regrowth may occur spontaneously, even after several months. Alopecia areata is characterized by relapses and periods of symptom exacerbation.

Three types of alopecia areata

In medicine, there are three main types of alopecia areata:

• patchy,
• generalized,
• total.

Patchy alopecia areata involves round or oval bald patches on the scalp that may merge together. Generalized alopecia areata is characterized by the complete absence of hair on the scalp and other hair-bearing areas of the body. Total alopecia areata affects only the scalp. The disease manifests as partial or complete baldness without additional skin changes. Only about 12% of patients show nail changes such as local fibrosis and nail splitting.

What are the causes of alopecia areata?

It is certain that genetic factors contribute to the disease. The most frequently cited causes are autoimmune disorders. The main underlying conditions mentioned by doctors include type 1 diabetes, lupus erythematosus, vitiligo, and thyroid inflammation – Hashimoto’s disease. Proper treatment of the underlying condition may help stop or reduce hair loss.

Some researchers believe the disease may be hereditary — affecting 20–60% of patients. The incidence is higher in identical twins and first-degree relatives. The condition is also seen in about 10% of patients with Down syndrome, linking it to genes located on chromosome 21. Psychological and dermatological factors, such as long-term stress and strong emotional states, are also believed to play a role.

Other possible causes include disturbances in the hair growth cycle, poor blood circulation in the scalp, and deficiencies in certain vitamins and minerals.

How to recognize alopecia areata?
If you notice symptoms of alopecia areata, you should see a dermatologist or trichologist. Diagnosis of alopecia areata is usually straightforward, as a specialist can often make a diagnosis simply by examining the scalp and hair. Sometimes blood tests (iron levels, vitamins, macro- and microelements) may be recommended.

Read more: How does a hair and scalp examination look like?

Diagnosis can also be supported by a scalp biopsy or genetic testing for hair fragility and hair loss predispositions.

Alopecia areata in children

Many people are surprised that alopecia areata can also affect children. Even very young children may lose hair, just like adults. Causes may include vitamin deficiencies, illnesses, or wearing tightly tied hairstyles such as ponytails. The first signs of hair disease in children may persist into adulthood, which is why observing a child and consulting a specialist when excessive hair loss occurs is so important.

What causes alopecia areata in children?
Although not fully understood, possible causes include:

• Psychogenic factors – emotional stress and tension. These negatively impact the immune system, weakening hair follicles. Emotional strain may also disturb neuropeptide production, increasing immune reactivity. For predisposed children, this can lead to follicular infiltrates. Stressful events like starting school, exams, or changes in environment are frequent triggers.
• Autoimmune causes – other coexisting autoimmune diseases, especially thyroid disorders.
• Genetic factors – about 20% of children with alopecia areata have a positive family history.

Chronic inflammatory conditions involving hair follicles may also cause alopecia areata in children, leading to patchy baldness or even complete hair loss, including eyebrows, eyelashes, and body hair.

Symptoms of alopecia areata in children
It usually presents as patches of baldness on the scalp but may occur anywhere hair grows. Sometimes redness appears in the affected area. Characteristic signs include oval or round patches with broken or falling hair, most often in the occipital and temporal regions.

Although alopecia areata in children does not directly affect general health, it can seriously impact mental well-being. The most common types in children include:

• Patchy alopecia areata – single or multiple oval/round bald spots.
• Ophiasis – a variant affecting hair around the scalp perimeter, sometimes leaving tufts of hair at the top.
• Total alopecia areata – complete hair loss on the scalp, including eyebrows and eyelashes.
• Generalized alopecia areata – the most severe form, with complete loss of hair on the scalp and body.

Treatment of alopecia areata in children
Treatment depends on the underlying cause. Various topical preparations and treatments aim to improve blood circulation in affected areas, such as:

• Mesotherapy,
• PRP (platelet-rich plasma) therapy,
• Phototherapy,
• Radiofrequency,
• Ultrasound therapy.

Other effective approaches include psychological support, therapy groups, and stress reduction. For older children, identifying stressors (e.g., school environment) and making changes may help. Support groups can also ease acceptance of hair loss. Complete remission is sometimes possible in young patients with total or generalized alopecia.

The therapeutic process is similar to adults, but limited by the immaturity of the skin, immune system, and cooperation between child and physician.

In our Clinic, we use irritant topical agents to increase blood flow, as well as ointments with anthralin in cocoa butter or coconut oil. We also recommend calcineurin inhibitors and procaine penicillin (for children over 2 years old).

Alongside conventional therapy, natural medicine approaches may also support treatment, including:

• Acupuncture,
• Scalp massage,
• Aromatherapy,
• Homeopathic remedies,
• Evening primrose oil,
• Herbs (yarrow, nettle, horsetail),
• Aloe vera extract,
• Urine therapy.

However, home remedies should only complement medical treatment. The foundation should always be dermatological care and conventional therapy.

If any symptoms of alopecia areata appear in a child, it is crucial to consult a trichologist promptly. The specialist will identify the cause, rule out dangerous conditions, and recommend an appropriate treatment plan.

How to treat alopecia areata?

There are several effective methods for treating alopecia areata. Topical options include corticosteroids, minoxidil, dithranol, calcineurin inhibitors, diphenylcyclopropenone (DPCP), squaric acid dibutyl ester (SADBE), and dinitrochlorobenzene (DNCB). In some cases, triamcinolone injections into affected areas are recommended.

Photochemotherapy (UV, 3 times weekly) is highly effective with minimal side effects, stimulating follicle growth. It combines psoralen administration (e.g., methoxsalen at 0.5 mg/kg body weight) with UV light exposure. Possible side effects include nausea, malaise, and headaches.

Immunotherapy with DPCP and DNCB is another option, inducing sensitization of the skin. Treatment starts with 2% solution and then continues with progressively lower concentrations. This therapy must only be conducted in specialist centers, with effectiveness assessed after around 3 months.

Treatment of alopecia areata should always be managed by an experienced specialist, who can provide both diagnosis and an individualized treatment plan.

Common treatment options also include various topical drugs and medical procedures, such as:

• Scalp mesotherapy – injections of nutrient cocktails, often platelet-rich plasma (PRP) taken from the patient’s own blood.
• UVA/UVB/PUVA/LED/Excimer laser therapy – non-invasive, painless light-based treatments.
• Cryomassage (Cryo-S) – nitrous oxide is applied to cool tissues and stimulate hair regrowth.
• Dr. CYJ Hair Filler – injection of a peptide and hyaluronic acid complex.
• Carboxytherapy – intradermal CO₂ injections improving circulation and stimulating new vessel growth.
• Dermarollers,
• Topical irritants – DCP, anthralin, tar preparations.

Each case requires an individual treatment plan. To achieve results, therapies must be carried out as a full series. Only consistent treatment brings the expected outcome.