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What Are the Different Types of Alopecia Areata
By Kristeen Cherney, PhDMedically Reviewed by Mohiba Tareen, MDReviewed: June 15, 2022Medically ReviewedDepending on the type, alopecia areata can cause near or total hair loss on various parts of the body, including the head.Igor Novakovic/Getty ImagesAlopecia areata (AA) is an autoimmune condition that’s caused by the immune system’s attack on hair follicles. “When this happens, the hairs gradually become thinner until they stop growing entirely,” says Michele Green, MD, a New York City–based cosmetic dermatologist.Most cases of AA impact the scalp and face, but some types involve hair loss on other parts of the body. It’s estimated that AA impacts 2 percent of people globally. Yet such statistics may be an underestimation, as the prevalence continues to increase with proper diagnosis. In the United States, at least 2.5 million people may have AA. “Having a family member with alopecia areata increases one’s risk for developing the condition,” explains Brittany Craiglow, MD, of Dermatology Physicians of Connecticut and 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, with genetic components suspected. However, each subtype may be classified based on severity, onset, and extent of hair loss. The main types of AA are: Patchy alopecia areataAlopecia totalisAlopecia 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. Editor' s Picks
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Patchy alopecia areata involves patches of hair loss on the scalp, and sometimes in other areas of the body. This is the most common type of AA, and it tends to cause hair to fall out in the size of coins. “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. However, 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. 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. Alopecia Totalis
Alopecia totalis involves more widespread scalp hair loss compared with patchy forms, causing complete 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, one meta-analysis published in the Journal of the American Academy of Dermatology found that alopecia totalis accounts 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. 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 impacts an estimated 0.03 percent of people who have AA worldwide, according to the same meta-analysis. Between 30,000 and 200,000 people have alopecia universalis in the United States, and researchers believe that a genetic mutation within chromosome 8p12 may be involved in its development. In addition to patches of hair loss on the scalp and body, alopecia universalis can cause an absence of eyebrows and eyelashes, as well as hair loss in your ears, nose, arms, underarms, legs, and pubic area. 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. Diffuse Alopecia Areata
Diffuse alopecia areata is a less common form that involves sudden and widespread scalp hair thinning. This condition may also be misdiagnosed as other forms of hair loss. “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
Ophiasis alopecia also affects the scalp like diffuse alopecia. However, 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. Nail Changes in Alopecia Areata
Additionally, while not an official subtype, AA may also cause nail problems in some people who also have extensive hair loss. Nail symptoms may affect 10 to 20 percent of people with AA, and may cause the following symptoms: Extremely brittle nails, which may splitRed-colored nailsPits or ridges in the nailsTexture changes that are rough and may feel like sandpaper Summary
AA is an autoimmune disease that causes mild to severe hair loss, which may have a gradual or sudden onset. Depending on the type you have, AA can cause either patchy or widespread hair loss on the scalp as well as other parts of the body.Also, although studies have shown that AA is more prevalent in children than adults, this autoimmune disease may develop at any time. “Hair loss can be reversible with early detection and treatment, although some forms of hair loss are irreversible,” says Green. She also stresses the importance of seeing a dermatologist for an accurate diagnosis. Editorial Sources and Fact-Checking
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. August 19, 2019.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.Show LessNEWSLETTERS Sign up for our Healthy Living Newsletter
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