She found the first patch on a Tuesday. Small, perfectly round, and completely smooth at the back of her head where her ponytail always sat. She called it a fluke and covered it up. By the following week there were two more. That is how alopecia areata often announces itself — suddenly, without obvious reason, and in a way that feels like the ground shifting beneath you.
Alopecia areata affects millions of people worldwide and is one of the most emotionally difficult forms of hair loss precisely because of its unpredictability. As a second generation hair doctor I have worked with women who came to me months and years after their first patch appeared still without clear answers about what was causing it or what they could do. This article is for them and for anyone who has recently received this diagnosis or suspects they might have it.
Alopecia areata is not a sentence. The follicle is not destroyed. It is sleeping. And in many cases with the right clinical support it wakes back up.
Kristy Jarrett, CT Certified Trichologist and Second Generation Hair DoctorWhat Alopecia Areata Actually Is
Alopecia areata is an autoimmune condition. This means it is caused by the immune system mistakenly identifying the hair follicle as a threat and attacking it. When the follicle is under immune attack it enters a prolonged resting phase and stops producing hair. The result is the characteristic smooth, round or oval patch of hair loss with normal looking skin in the affected area.
Critically, in alopecia areata the follicle itself is not destroyed. It is suppressed. This distinction is enormously important because it means that the biological machinery for hair growth is still present and intact. The potential for regrowth exists as long as the follicle has not been permanently scarred, which is not what happens with alopecia areata.
This is what separates alopecia areata from scarring alopecias such as lichen planopilaris or frontal fibrosing alopecia, where the follicle is replaced by scar tissue and hair loss in those areas is generally permanent. Understanding exactly which type of alopecia you are dealing with is the first and most important step because the clinical approach differs entirely.
The Different Forms of Alopecia Areata
The most common form. One or more discrete round or oval patches of hair loss on the scalp or body. Patches can appear, stabilize, regrow, or spread unpredictably.
Complete loss of all scalp hair. A more advanced progression of patchy alopecia areata that can develop over time as patches merge and expand.
Complete loss of hair on the scalp and body including eyebrows, eyelashes, and body hair. The most extensive form of the condition.
Hair loss that follows a band-like pattern around the sides and back of the scalp. This form can be more challenging to treat than the classic patchy presentation.
What Causes It and What Triggers It
The underlying susceptibility to alopecia areata is genetic. If you have a first degree relative with the condition your own risk is elevated. However having the genetic predisposition does not mean alopecia areata is inevitable. Many people carry the genes associated with the condition and never develop it. Something triggers the immune system to cross the threshold from predisposition into active disease.
The triggers most commonly associated with onset or flare of alopecia areata include:
- A significant physical illness or infection, particularly viral illnesses, which can prompt immune dysregulation
- Sustained psychological stress, which affects immune function in complex ways that are not fully understood
- Hormonal changes including pregnancy, postpartum changes, and perimenopause
- Other autoimmune conditions including thyroid disease, vitiligo, and type 1 diabetes which often co-occur with alopecia areata
- Physical trauma to the scalp in some cases
Understanding the trigger does not reverse the condition but it does inform the clinical approach. Someone whose alopecia areata was triggered by a thyroid condition needs that thyroid condition properly managed as part of any effective treatment plan. Someone whose onset followed a period of extreme stress benefits from stress management as part of the overall protocol.
How It Is Diagnosed
Alopecia areata has a fairly characteristic clinical presentation but it can be misidentified, particularly in its early stages. Correct diagnosis matters enormously because treating alopecia areata as if it were androgenetic alopecia or seborrheic dermatitis produces no results and can cost months of effective treatment time.
The key features that distinguish alopecia areata in a clinical assessment are the smooth skin surface in the affected area with no scaling, redness, or follicular changes, the discrete circular or oval shape of the patches, the presence of exclamation mark hairs at the active edge of a patch, and the history of sudden onset without a preceding period of diffuse shedding.
A microscopic scalp assessment at the patch border is one of the most useful diagnostic tools. The pattern of follicular involvement seen under magnification differs meaningfully between alopecia areata, traction alopecia, and androgenetic alopecia. This is one of the reasons a proper clinical consultation gives you far more useful information than a visual assessment alone.
What Treatment for Alopecia Areata Looks Like
There is no universally curative treatment for alopecia areata. What exists is a range of approaches that can suppress the immune activity attacking the follicle, support the scalp environment for regrowth, and manage the emotional and practical impact of the condition. The right combination depends entirely on the individual, the extent of involvement, the duration of the condition, and how it has responded to previous interventions.
At GlamorChiQ the alopecia treatment program for clients with alopecia areata focuses on the areas where non-medical intervention can make a meaningful difference. A thorough trichology consultation establishes the extent of the condition, whether it appears to be in an active or stable phase, and whether there are secondary scalp health factors that may be sustaining the immune activity or compromising the environment for potential regrowth.
From that baseline a targeted protocol addresses scalp inflammation, improves circulation to resting follicles, and creates the healthiest possible environment for the immune suppression to lift and regrowth to occur. For clients with more extensive involvement or cases that require medical intervention, I work to ensure they have the information they need to pursue those options in parallel.
What I always emphasize to clients with alopecia areata is that the unpredictability of the condition, while difficult to live with, also means that spontaneous remission is genuinely possible. I have seen women regrow significant amounts of hair after years of loss. The goal of clinical support is to give the follicle every possible advantage when that window opens.
Living With Alopecia Areata
One of the most important things I can offer clients with alopecia areata is honesty about the emotional reality of the condition. Hair loss of any kind carries a significant psychological weight for women. Alopecia areata, with its unpredictability and visual prominence, carries more than most. The anxiety about whether patches will expand, whether regrowth will hold, whether a good period is about to end — these are real and valid experiences that deserve acknowledgment.
For women in active loss who need coverage options while treatment is underway, hair replacement options can provide a sense of normalcy and control during an otherwise uncertain period. These are not concessions or giving up. They are practical tools that support quality of life while the clinical work continues.
If you are experiencing patchy hair loss and are not sure whether it is alopecia areata or another form of loss, the most important thing you can do is get a proper clinical assessment before drawing conclusions. There are many causes of hair loss in women and the treatment approach for each one is different. Starting with the right information is the difference between months of effective treatment and months of treating the wrong thing.
Dealing with patchy hair loss and not sure what it is?
A clinical assessment with Kristy will tell you exactly what you are dealing with and what approach makes the most sense for your specific situation. Virtual and in person consultations available in Memphis and across the US.
Book Your ConsultationFrequently Asked Questions About Alopecia Areata
Alopecia areata is an autoimmune condition in which the immune system mistakenly attacks the hair follicles, causing them to stop producing hair. The underlying susceptibility is genetic and various triggers including illness, stress, hormonal changes, and other autoimmune conditions can prompt the onset or flare of the condition.
Yes. Because the follicle is suppressed rather than destroyed in alopecia areata, regrowth is biologically possible. Many cases resolve spontaneously with or without treatment. Clinical support through the alopecia treatment program aims to create the best possible environment for regrowth to occur when the immune activity subsides.
Alopecia areata typically presents as one or more smooth, round or oval patches of hair loss on the scalp. The skin in the patch is usually normal looking with no scaling or redness. Short broken hairs called exclamation mark hairs may be visible at the edges of active patches. The presentation can look similar to other forms of hair loss which is why clinical assessment is important for accurate identification.
Alopecia areata is specifically autoimmune causing patchy non-scarring loss. It differs from androgenetic alopecia which causes gradual diffuse thinning, from traction alopecia which is caused by tension, and from telogen effluvium which causes diffuse shedding. Correct identification is essential because treatment approaches differ significantly between types.
GlamorChiQ in Memphis TN offers clinical alopecia treatment led by Kristy Jarrett, a CT Certified Trichologist with over 25 years of experience. Both virtual and in person consultations are available. Book a consultation here.
