ARTICLE
Alopecia areata rarely announces itself. Most people find it by accident, a barber notices a bare patch, or a hand runs over the scalp and finds smooth skin where hair should be. The patch is usually round, the edges are clean, and the skin underneath looks entirely normal.
That last detail is what separates it from most other causes of hair loss, and it is also the clue to what is happening. This article explains what causes alopecia areata, written by the physicians at AyurMana, a residential Ayurveda hospital in Trivandrum, Kerala.
What alopecia areata is
Alopecia areata is an autoimmune condition in which the immune system attacks the hair follicles. It affects roughly two percent of people at some point in life, across all ages, though it most often begins before the age of forty.
The important thing to understand is that the follicles are not destroyed. They are switched off. This is why regrowth remains possible even after long periods, and why the outlook is generally better than people fear when they first see a bare patch.
It usually appears on the scalp but can affect the beard, eyebrows, eyelashes or any hair bearing area.
Why hair falls out in patches
Hair follicles normally sit in what researchers describe as an immune privileged state, meaning the immune system leaves them alone. In alopecia areata that privilege breaks down. Immune cells gather around the follicle and interrupt its growth cycle, and the hair in that area is shed.
The patches are round because the process spreads outward from a point rather than affecting the scalp evenly. The skin looks normal because only the follicle is affected, not the surrounding tissue.
Short broken hairs are sometimes visible at the edge of a patch, thinner at the base than the tip. These are called exclamation mark hairs and they usually indicate that the patch is still active.
Autoimmune and genetic factors
Other autoimmune conditions
Alopecia areata occurs more frequently alongside thyroid disease, vitiligo, type 1 diabetes and rheumatoid arthritis. Anyone diagnosed is usually worth screening for thyroid function, since thyroid disorders are both common and treatable.
Family history
Around one in five people with alopecia areata has a relative who has had it. That indicates genetic susceptibility rather than direct inheritance. Most children of an affected parent never develop it.
Age of onset
It can begin at any age, though onset in childhood is generally associated with a more variable course than onset in adulthood.
Stress and other triggers
Patients very often describe the patches appearing after a period of significant stress. A bereavement, an illness, an examination period, a difficult few months at work.
The honest position is that the relationship is not fully established. Stress is unlikely to cause alopecia areata by itself, since most people under stress do not develop it. What seems more likely is that stress acts as a trigger in someone already susceptible.
Other reported triggers include viral illness, vaccination in isolated cases, and physical injury to the scalp, though none of these is consistently found.
What we would caution against is the belief that the patient caused this by not managing their stress well enough. That is neither accurate nor helpful, and we hear it from patients often.
Does the hair grow back
In many cases, yes. For a single small patch, spontaneous regrowth within six to twelve months is common, sometimes without any treatment at all.
Regrowth is often white or fine at first before the normal colour and thickness return. This is expected and not a sign that something has gone wrong.
The course is less predictable where there are multiple patches, where it has begun in childhood, or where there is extensive involvement. Recurrence is possible even after full regrowth, and there is no way to predict with certainty who will have a single episode and who will have a recurring pattern.
How Ayurveda approaches it
In Ayurveda, patchy hair loss of this kind is described as Indralupta. It is understood as a condition involving Pitta and Rakta, the blood tissue, with Vata contributing to the sudden onset and the shedding itself.
The approach therefore looks beyond the scalp. Digestion, sleep and the patient’s general state are assessed alongside the patches, on the understanding that a condition arising from within is not resolved by treating only the surface.
Treatment may include external applications to the affected area, internal preparations selected after assessment, and where appropriate, Panchakarma procedures. What is used depends on the individual rather than following a fixed protocol.
We should be direct about outcomes. No system of medicine can guarantee regrowth in alopecia areata, because the course of the condition itself is unpredictable. What careful treatment can do is support the process and address the wider factors involved.
When to see a physician
- A patch that is enlarging, or new patches appearing
- Loss of eyebrow or eyelash hair
- Nail changes, particularly small pits or ridges
- Associated symptoms such as fatigue, weight change or feeling cold, which may point to thyroid involvement
- Hair loss that is diffuse rather than patchy, which usually has a different cause and needs a different assessment
Earlier assessment gives more options. Patches that are recent and still active generally respond better than those present for many years.
Frequently asked questions
Is alopecia areata the same as ordinary hair fall?
No. Ordinary hair fall is diffuse, spread across the scalp, and usually related to nutrition, hormones or male or female pattern loss. Alopecia areata produces discrete round patches with normal looking skin.
Will it spread to my whole scalp?
In most people it does not. Extensive loss occurs in a minority of cases. A single patch most commonly stays as a single patch.
Is it caused by using too much oil or shampoo?
No. It is an immune condition. Hair products do not cause it, though harsh treatment of an affected area is worth avoiding.
Can it be cured permanently?
Regrowth is common but recurrence is possible. No treatment in any system can guarantee that it will not return, and you should be cautious of anyone who promises that.
Should I cover the patch?
That is entirely your choice. There is no medical need to cover it. Many people do for comfort and that is perfectly reasonable.
Does diet matter?
Correcting any deficiency, particularly iron, vitamin D or B12, is worth doing. Beyond that, no specific diet has been shown to resolve alopecia areata.
Speak to our physicians
If patches have appeared recently or are spreading, an early assessment is worth having. Our physicians at AyurMana in Trivandrum, Kerala can help. Get in touch to arrange a consultation.
