Hair loss—called alopecia areata—can be upsetting. If it affects you, you may feel as if you’re the only one, but it’s more common than you think. About seven million Americans have alopecia areata, including men, women, and children of all ethnic groups.
In this Q&A, Emma Guttman-Yassky, MD, PhD, Waldman Professor and Health System Chair of Dermatology at the Icahn School of Medicine at Mount in New York and Director of the Alopecia Areata Center of Excellence at Mount Sinai, explains the condition, its risk factors, and who to contact for treatment.
What is alopecia areata?
Alopecia areata is an autoimmune disease that causes you to lose your hair, mostly on the scalp. An autoimmune condition means your body’s own immune system is attacking a certain part of your body. In this case, the system attacks healthy hair follicles. Alopecia areata often starts with one or more circular patches about the size of a quarter. Hair may disappear suddenly, over just a few days, or it may fall out slowly, over weeks or months. This condition can spread to other parts of the body, such as the eyebrows, eyelashes, beard, and extremities. The condition is not linked to food. There’s nothing you should eat—or avoid—to prevent it. If you are an alopecia patient, you can eat whatever you want.
What causes the condition? Who is most at risk?
This condition does not discriminate. It affects people of all ages, genders, and backgrounds. It often starts in childhood or adolescence but can affect those well into adulthood.
Alopecia areata can be triggered by a significant event, such as an illness or trauma, or it can arise due to genetics or a family history of eczema or another allergy. We see more alopecia areata in families of patients who have had the condition. We also see it in families that have eczema. While some people think it can be caused by stress, there is no scientific data to back that up. Alopecia is not contagious.
Can hair loss affect you emotionally?
If you’re feeling anxious or depressed over your hair loss, that’s not unusual. Hair can be an important part of our identity. And baldness—in patches or all over your head—can be devastating. It can make you feel self-conscious and unhappy about your appearance. According to the National Institute of Mental Health, people with long-term alopecia areata are at a higher risk of depression. So, if you’re feeling sad or uncomfortable about the condition, you are not alone.
Should I see a doctor if I think I have alopecia?
You should see a doctor as soon as you notice a problem. Some mild forms of the disease improve on their own, but most people need medical intervention. I recommend seeing a specialist, because many primary care physicians don’t know how to treat alopecia. At the Alopecia Areata Center of Excellence at Mount Sinai, we have special expertise in diagnosing and treating alopecia areata and cicatricial alopecia.
We have found that patients with alopecia have more systemic inflammation than patients with other skin conditions, such as psoriasis or eczema. Over a long period, inflammation that is systemic—affecting many or all parts of the body—can cause a number of problems including heart disease, arthritis, Alzheimer’s disease, and cancer. Getting treatment early can help prevent alopecia from developing into these conditions.
How is the condition treated?
The first step is to evaluate your symptoms and the type of cells that are causing the inflammation. Dermatologists will then use a variety of treatments, including systemic (oral or biologic), topical, and injected anti-inflammatory medications. In addition, at Mount Sinai’s Alopecia Areata Center of Excellence, we are researching new treatments for the conditions, so we may be able to include you in a clinical trial.