What Are the Different Types of Alopecia Areata?

Types of Alopecia Areata
Depending on the type, alopecia areata can cause near or total hair loss on various parts of the body, including the head.Igor Novakovic/Getty Images

Alopecia areata (AA) is an autoimmune condition that’s caused by the immune system’s attack on hair follicles, affecting new hair growth.

“When this happens, the hairs gradually become thinner until they stop growing entirely,” says Michele Green, MD, a cosmetic dermatologist in New York City.

Most cases of AA impact the scalp and face, but some types involve hair loss on other parts of the body, per the National Institutes of Health (NIH).

It’s estimated that AA affects 2 percent of people globally. Yet such statistics may be an underestimation, because current research suggests the prevalence continues to increase with proper diagnosis, per a systematic review and meta-analysis?in the March 2020 Journal of the American Academy of Dermatology. In the United States, at least 2.5 million people may have AA, according to the?National Organization for Rare Disorders (NORD).

“Having a family member with alopecia areata increases one’s risk for developing the condition,” explains Brittany Craiglow, MD, who practices at Dermatology Physicians of Connecticut and is an associate adjunct professor of dermatology at the Yale School of Medicine in New Haven. “People who have atopic dermatitis (eczema), asthma, thyroid disease, vitiligo, and Down syndrome are also more likely to develop it.”

Overall, AA is caused by the same autoimmune response in the body as the aforementioned other health conditions, with genetic factors suspected. It’s characterized by an immune system that attacks hair follicles, affecting the way your hair grows. This may affect the hair on your scalp, your body hair, or both. Each subtype is classified on the basis of severity, onset, and extent of hair loss. Per the NIH, the main types of AA are:

  • Patchy alopecia areata
  • Alopecia totalis
  • Alopecia universalis

Read on to learn more about the types of alopecia areata, how common they are, and what their potential signs and symptoms may be.

Patchy Alopecia Areata

Patchy alopecia areata involves patches of hair loss on the scalp, and it sometimes happens in other areas of the body. This is the most common type of AA, and it tends to cause hair to fall out in coin-size patches, per the NIH.

“Alopecia areata represents a spectrum of disease,” says Dr. Craiglow.?“Most people have mild, patchy disease with one or a few spots of hair loss, which are often round.”

The hair loss that comes with patchy AA is sudden, though some people report symptoms of tingling or burning before the affected hairs fall out. There are no rashes or scars at the site of hair loss. You may also notice that the hairs immediately surrounding the patch(es) of hair loss are shorter, and may stand up straight like exclamation points.

The progression of patchy AA varies, and the affected hairs may grow back. Sometimes, hair regrowth will occur within a few months, though new hairs may be gray or white at first. In other cases, patchy AA may progress to more severe types that lead to more widespread hair losses in other parts of the body. In more severe disease, it’s possible to experience AA that affects both the hair on your scalp as well as your body hair, per the NIH.

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Alopecia Totalis

According to the NIH, alopecia totalis involves more widespread scalp hair loss than patchy forms of the condition, causing complete baldness in severe cases, or near-complete scalp hair loss. At first, you may see a few small patches of hair loss that multiply and eventually join together and form larger patches.

Overall, alopecia totalis is considered rare. In fact, the Journal of the American Academy of Dermatology?meta-analysis?found that alopecia totalis accounted for about 0.08 percent of all AA cases worldwide. Nonetheless, the exact prevalence of this type of AA in the United States is unknown, notes the NIH.

Alopecia Universalis

Like alopecia totalis, alopecia universalis can cause near or complete scalp hair loss. The difference with alopecia universalis is that it also involves complete or widespread hair loss on your face, as well as the rest of your body. This is the rarest, but most severe type of alopecia areata, which affects an estimated 0.03 percent of people who have AA worldwide, according to the aforementioned meta-analysis. Between 30,000 and 200,000 people have alopecia universalis in the United States, according to the NIH’s Genetic and Rare Diseases Information Center (GARD). While the exact causes are unknown, researchers believe that a genetic mutation within chromosome 8p12 may be involved in its development, per NORD.

In addition to patches of hair you might lose on the scalp and body, alopecia universalis can cause an absence of eyebrows and eyelashes, as well as increased risk of hair loss in your ears, nose, arms, underarms, legs, and pubic area, according to FamilyDoctor.org.

Other Types and Symptoms of Alopecia Areata

The primary forms of AA are patchy alopecia areata, alopecia totalis, and alopecia universalis, there are other important types to know, including diffuse and ophiasis forms. Also, AA can cause nail symptoms in some people. Here’s a breakdown of other symptoms of these less-common subtypes.

Diffuse Alopecia Areata

Diffuse alopecia areata is an unusual form that occurs suddenly and involves widespread scalp hair thinning. This condition may also be misdiagnosed as other forms of hair loss, according to the National Alopecia Areata Foundation (NAAF).

“Diffuse alopecia areata presents itself as sudden thinning of the hair all over the scalp and is often confused with androgenetic alopecia (male or female pattern hair loss) or telogen effluvium (temporary hair loss due to a trigger),” says Dr. Green.

Ophiasis Alopecia

Like diffuse alopecia, ophiasis alopecia affects the scalp. But the associated hair loss forms a unique pattern along the occipital region of the scalp, which encompasses the sides and lower back portions into the shape of a large strip. This type may also be one of the most difficult to treat, per the NAAF.

Nail Changes in Alopecia Areata

Additionally, while not an official subtype, AA may also cause nail problems in both the fingernails and toenails in some people who also have extensive hair loss, per the NIH. Nail changes may affect 10 to 20 percent of people with AA, and may cause the following symptoms, according to the American Academy of Dermatology Association (AAD).

  • Extremely brittle nails, which may split
  • Red-colored nails
  • Pitting or ridges in the nails
  • Texture changes that are rough and may feel like or have the appearance of sandpaper

Summary

AA is an autoimmune disease that causes mild to severe hair loss, which may have a gradual or sudden onset in the affected areas. Depending on the type you have, AA can cause either patchy or widespread hair loss on the scalp as well as bald patches on other parts of the body.

Also, although research has shown that AA is more prevalent in children than adults, this autoimmune disease may develop at any age.

“Hair loss can be reversible with early detection and treatment, although some forms of hair loss are irreversible,” says Green. She stresses the importance of a dermatologist visit for an accurate alopecia areata diagnosis and to discuss your treatment options. This type of doctor specializes in diseases of the skin and hair, and can recognize the type of AA you may be experiencing.

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Resources

  • Alopecia Areata. National Institute of Arthritis and Musculoskeletal and Skin Diseases. April 2021.
  • Lee HH, Gwillim E, Patel KR, et al. Epidemiology of Alopecia Areata, Ophiasis, Totalis, and Universalis: A Systematic Review and Meta-Analysis. Journal of the American Academy of Dermatology. March 2020.
  • Alopecia Totalis. Genetic and Rare Disease Information Center. November 8, 2021.
  • Alopecia Universalis. Genetic and Rare Diseases Information Center. November 8, 2021.
  • Alopecia Areata. American Academy of Family Physicians. July 2, 2021.
  • Alopecia Areata. National Organization for Rare Disorders.
  • Types of Alopecia Areata. National Alopecia Areata Foundation.
  • Hair Loss Types: Alopecia Areata Signs and Symptoms. American Academy of Dermatology Association.
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