This type of alopecia affects 2% of the worldwide population and 1 in 170 people in the UK [1], so many people are eager to learn how to stop alopecia areata from spreading. In most cases, this condition resolves on its own within the year, but over 90% of people who experienced it once will develop further flare-ups in the future. And 30% of them will see their hair loss progress to alopecia totalis (total loss of scalp hair) or even alopecia universalis (total loss of body hair) [2].
Since alopecia areata is an autoimmune condition, its progression is not fully within medical control. Available medications may work for mild to moderate forms, while more advanced ones may be resistant to treatment. So is there anything at all you can do to limit the hair loss caused by this condition? Learn to discern between hair loss treatment myths and scientifically proven alopecia areata solutions by gaining insight into:
You can’t always tell if your alopecia areata is likely to spread. Each case is different, and not everyone has progressive alopecia areata. Studies have shown that up to half of all patients can recover within a year even without treatment [2]. However, other research shows that approximately 30% of patients with this type of alopecia will progress to complete hair loss [2].
You’re more likely to have progressive or severe alopecia areata if [2][3]:
Myth:
If your hair has grown back without treatment before after an alopecia areata flare, it will do so every time.
Fact:
There is no guarantee that your alopecia areata won’t progress in time if your previous episodes had a positive outcome. If you notice your current flare-up is lasting over a year or your hair loss is spreading, it’s best to see a trichologist who can recommend treatment as needed.
Normally, alopecia areata involves rapid hair loss that can occur over weeks. If you have been experiencing this condition and are concerned it may be progressing, the best thing you can do is to take photos of your scalp every 2-3 days and compare them.
If you can see a widening of the existing bald patches, new ones starting to emerge or even sudden diffuse hair thinning, it is best to see a trichologist as soon as possible to discuss treatment options.
Other signs that your alopecia may be advancing may include [4]:
Alopecia areata can only affect your scalp hair.
This condition can spread to your facial hair as well, affecting your eyelashes eyebrows, beard and/or moustache. In severe cases, your entire body may become affected (you can develop alopecia universalis).
Alopecia areata is an autoimmune type of hair loss, which means your white blood cells are attacking your hair follicles. It also has a genetic component, as 20% of people who experience it have a family history of this condition [5].
In most people, alopecia areata resolves itself within a year from its onset, but it often flares again over time. However, sometimes the hair loss may take years and require treatment to improve or it may become permanent. And in almost one-third of those who experience this condition, it can progress to full baldness.
The typical presentation of alopecia areata is with small, round, smooth, bald patches on your scalp or in your facial hair. However, rare forms can also cause diffuse hair loss on your scalp (alopecia areata incognita), swathes of hair loss at the back or sides of your head (alopecia ophiasis). total baldness on your scalp and face (alopecia totalis) or full body hair loss (alopecia universalis).
Other symptoms of this condition include short, broken hairs that look like exclamation marks, and in approximately 10% of patients, pitted nails.
There are several possible triggers for an alopecia flare-up, although the cause is often unknown. Some known triggers include:
Episodes of alopecia areata can vary in length. 30-50% of patients with patchy alopecia areata see improvements without treatment within six to 12 months [10]. Two-thirds of patients will have complete regrowth within five years. It’s less common for a single episode of alopecia areata to last longer than two years. One study examined the duration of a current episode of alopecia areata for 50 patients [11]:
There isn’t a single reason why alopecia areata spreads in some people and does not in others. We know that about 50% of patients with this condition who reach secondary care go into remission within a year. But that is mostly true for those who experience milder forms, as only less than 10% of those with extensive hair loss share this outcome [2].
However, the reason why some have milder, self-contained forms and others have more advanced and spreading varieties of alopecia areata depends on a number of genetic, immune, hormonal and environmental factors. Each of our bodies is different and so are our lifestyles and our experiences. When all these factors mix in a certain way, they can trigger a flare-up or cause your alopecia areata to spread.
If your alopecia areata is spreading despite being treated, it means you are getting the wrong treatment.
While it is possible that you may need a treatment adjustment, that is not always the case. Some forms of this condition are simply recalcitrant and will progress even when treated correctly. However, in some cases, the medication may help slow down or reduce its progression.
Regardless of what the media may tell you, there is no simple answer to this question. Some forms of alopecia areata will not spread and will resolve themselves in a few months without any treatment (but will often flare again at a later time). Others (especially mild to moderate ones) can be managed successfully with treatment, which reduces symptoms and stops the condition from progressing.
However, there are also forms of alopecia areata which are resistant to all available treatments and will progress regardless of any steps taken to prevent this. This is more often the case of advanced forms, such as ophiasis alopecia, which frequently have poor outcomes.
The reason why the evolution of this condition is difficult to predict is that it is an autoimmune condition based on a genetic predisposition [3] and it is hard to tell how your genes will affect your immune response over time.
While you may not always be able to stop your alopecia areata from progressing, there are many cases where the right treatment can help. But there are also many harmful hair loss myths out there surrounding this condition. This section will reveal the best ways to keep your alopecia areata under control with evidence-based interventions.
While it is true that oftentimes this condition resolves on its own, it is still a good idea to see a hair doctor as soon as you see the first signs of hair thinning and balding. On one hand, they can help confirm the diagnosis – there are several other types of alopecia that can be mistaken for this condition, such as scarring alopecias, trichotillomania or tinea capitis (ringworm) [2].
Moreover, female pattern baldness can be mistaken for diffuse alopecia areata (or it can simply coexist with it). That is why it is good to get a professional diagnosis. On the other hand, if deemed necessary, your trichologist can recommend treatment that can curb your hair loss and perhaps prevent it from spreading.
If your alopecia areata is advanced and/or doesn’t resolve on its own, there are several treatments that can be effective in limiting it and achieving hair regrowth:
Corticosteroids
Topical steroid creams for hair loss can be effective for treating alopecia areata. They’re often used as a first-line treatment for patchy hair loss [2]. However, in some cases, intralesional steroid injections may be even more effective than topical creams [12]. They are known to be normally very effective against mild to moderate forms of alopecia areata, affecting under 50% of your scalp.
In these cases, clinical trials showed hair growth in 64%, respectively 97% of two groups of participants who received different types of steroid injections (triamcinolone hexacetonide and triamcinolone acetonide) [13].
Other studies show that corticosteroid injections can be effective even against more advanced hair loss. Various studies report between 25% and 83% hair regrowth in patients with moderate to extensive alopecia areata, depending on the extent of their condition and the type of steroid used [14].
While more research is needed to prove this effect, one study revealed that certain types of intralesional steroid injections can also improve the symptoms of 60% of patients with severe forms of this condition (50%-99% hair loss) [15].
Patient before and after 2% Minoxidil treatment [28]
Minoxidil
Minoxidil promotes hair growth by widening the blood vessels that feed your hair follicles. This increases blood flow, which means more nutrients reach the follicles, promoting healthy hair growth. Topical Minoxidil can stimulate new hair growth in those with mild to moderate alopecia areata. However, it’s less effective if your condition has already spread extensively [16]. Only 6-14% of patients with severe forms of this condition treated with Minoxidil 5% showed significant hair regrowth [17].
Oral Minoxidil also yields a rather weak response in advanced alopecia areata. One study shows that taking 5 mg of this medication every 12 hours produced a cosmetic response in 18% of patients with less than 75% hair loss and in 9% of those with over 75% shedding [18].
But it is good to keep in mind that Minoxidil does not have to be necessarily used on its own to treat alopecia areata. It can also be used alongside other treatments, as adjunctive therapy that can enhance their results [19].
Topical immunotherapy
Topical or contact immunotherapy is often used to treat alopecia areata, especially if it’s already started to spread [2].
It works by exposing you to an allergen, which induces a mild allergic reaction known as contact dermatitis. Weak versions of the allergen are then applied to your patches of alopecia on a regular basis.
This generates white blood cells which inhibit the autoimmune response that triggers alopecia areata, allowing your follicles to begin producing hair again.
Response rates of certain types of topical immunotherapy are [19]:
JAK inhibitors
Janus kinase (JAK) inhibitors block the activity of JAK enzymes, which transmit immune response signals throughout the body. By suppressing these signals, your body is less likely to attack the hair follicles as part of an autoimmune response.
JAK inhibitors aren’t widely used in the UK, but they do offer an effective alternative treatment to stop alopecia areata from spreading. In 2023, the US Food and Drug Administration licensed Olumiant as the first JAK inhibitor to treat alopecia areata. Baricitinib is also in phase 3 clinical trials, the final one before being FDA-approved, and is producing promising results.
Low level laser therapy
Low level laser therapy (LLLT) is a non-invasive treatment that’s shown promising signs of promoting regrowth in people with alopecia areata [22]. It works by concentrating low frequency laser beams at your bald patches, which stimulates your hair follicles for growth.
Red light therapy for hair growth is one of the most commonly used and effective forms of low-level light therapy. It uses red andor near-infrared light that is absorbed into your scalp, activating your cell mitochondria. This helps more energy reach your hair follicles faster, improving strand production.
A meta-analysis of studies conducted to test the efficacy of LLLT against alopecia areata shows efficiency levels comparable to those of intralesional corticosteroids: 36.9-100% efficiency with 50% or greater hair regrowth. However, it must be kept in mind that these studies were rather small (94 participants over 8 clinical trials) [23].
You can just buy over-the-counter hair growth treatments for your alopecia areata bald spots. They do wonders for male pattern baldness.
Different forms of alopecia areata require specific kinds of treatment, some of which are not available without a medical prescription. Furthermore, not all hair growth medicine that works for androgenetic alopecia is also effective against alopecia areata. While Minoxidil can, indeed, help manage its milder forms, drugs such as Finasteride or Dutasteride (some of the most effective against male pattern baldness) do nothing for this condition.
It is a known fact that smoking causes hair loss, among other (some very serious) health problems. It has been linked with higher incidences of alopecia areata and it can trigger flare-ups in some people [24]. That is because nicotine promotes inflammation in your body, including your scalp. It also constricts your blood vessels, which allows less blood flow (and thus, less oxygen and nutrients) to your hair follicles.
While e-cigarettes can provide a safer alternative to traditional ones, it is good to know that vaping may also cause hair loss if you are using e-liquid that contains nicotine. So if you have a history of alopecia areata, it is best to stay away from smoking altogether, especially during a flare-up. While vaping alone may not cause your condition to spread, it could add to other genetic, biological and environmental factors that can lead to this outcome.
You may already know that some vitamin deficiencies can cause hair loss. But it may surprise you to find out that they could also play a role in triggering or worsening your alopecia areata. For example, vitamin D deficiency has been linked to the development, flaring or spreading of this condition [25].
Moreover, your hair follicles need a variety of nutrients to be able to produce healthy hair. Even more so when they are under attack by your immune system. So you need to make sure that your diet provides all the vitamins, minerals and protein to create strong, healthy strands. You can achieve this by eating well-balanced meals, rich in vitamins A, B, C and D, iron, zinc, magnesium, and protein from healthy sources (e.g. nuts, seeds or leafy greens).
There are many connections between stress, anxiety and hair loss. And studies have found significant links between the triggering or worsening of alopecia areata and stressful life events. 45.6% of alopecia areata patients in one study [26] reported having experienced family problems 35.7% having experienced personal problems before the onset of their condition or of a flareup.
Of course, this doesn’t mean that stress alone can cause your alopecia areata, but it can trigger it when it overlaps with other predisposing factors. While adverse life events often cannot be avoided, you can take steps to reduce the chronic stress that comes with daily life.
The best way to do this is to develop a healthy self-care routine that allows you to unwind and recharge your psychological batteries. And active relaxation may be a good choice. This may include strolling in nature, practising meditation, exercising, engaging in entertaining hobbies or simply spending quality time with your loved ones.
No, alopecia areata is not contagious. That means it doesn’t spread through physical touch, even in situations of direct contact with the affected body parts. So you cannot catch it from a stranger, friend or lover and you cannot pass it on in turn.
Since this condition often develops in childhood, kids who experience it are likely to be shunned by their peers out of fear of contagion. This is not only unwarranted, but it can constitute a form of bullying and cause significant distress and mental health issues for the affected child.
If your child or teenager is affected by this condition, it is a good idea to get them psychological support. Working with their educators to raise awareness that alopecia areata cannot be spread by touching can also help their peers become more accepting.
Touching your own healthy scalp or facial hair after having touched your bald patches can make alopecia areata spread.
This condition does not spread to your other body parts through touch either. It is caused by your immune system attacking your hair follicles, not by microbes that can be physically spread around.
One study [27] showed that using a specific combination of essential oils for hair growth (thyme, rosemary, lavender and cedarwood essential oils, in jojoba and grapeseed carrier oils) for 7 months showed alopecia areata symptom improvement in 44% of the test group. The fact that only 15% of the control group also showed improvement means there may be some effectiveness to this treatment (although more research is needed).
Another study found that onion juice may also help improve symptoms of alopecia areata [30]. Onion oil for hair may have a similar effect, thanks to its antioxidant and anti-inflammatory properties.
However, there are very few natural remedies for hair loss caused by alopecia areata. That is partially because there haven’t been many clinical tests performed to test the effect of hair growth oils on this condition (though some of them may possess certain anti-inflammatory qualities). So if you would like to engage in proven, natural ways to manage your alopecia areata, the best things you can do is to reduce stress, quit smoking, and eat a balanced healthy hair diet.
Natural treatments for alopecia areata are better for your hair and scalp than hair loss medications.
If a trichologist recommends a certain medication for your alopecia areata, it means it is generally safe and necessary. While any treatment has side effects and certain medications may have more of them than natural solutions, they are also proven to be more effective, especially when it comes to more advanced alopecia areata.
Sadly, many commercially available natural products which promise miracle cures have no scientific basis for their claims. However, approved hair loss medications such as corticosteroids, immunotherapy or JAK inhibitors have years of clinical trials behind them to reveal their effectiveness and potential side effects.
Unfortunately, hair transplants for alopecia areata don’t often work. And they definitely can’t help prevent this condition from spreading. The reason is that when you are experiencing this type of alopecia, your hair follicles are not permanently damaged. The fact that you can go into spontaneous remission shows the hair roots are still fully able to create new strands once your white blood cells stop attacking them. So there would be no benefit from transplanting other follicles, which would also be impaired by your immune system.
However, in rare cases, hair transplants can be successfully performed in patients whose alopecia areata has been stable for at least 2 years. That means it has not improved but has not spread either. Relevant literature, however, mentions mostly eyebrow transplants, as it can be more difficult to successfully treat alopecia areata of the scalp with hair restoration surgery.
It is natural to be worried about the progression of your alopecia areata, especially if you are seeing signs of spreading. And the best thing you can do in this situation is to book a consultation with one of our experienced trichologists.
Our specialists are waiting at your most convenient clinic location to provide you with a thorough and complete assessment of your scalp condition. They will recommend the most effective, personalised treatments to curb your alopecia areata and work alongside you to take all the available steps to stop it from spreading.
Find out even more about how to keep your alopecia areata from spreading by reading the answers to these frequently asked questions:
While in some people, alopecia areata may indeed spread in time, this doesn’t happen in most cases. It normally involves flares that resolve themselves in a few months to a year.
It is true that if your flare lasts for several years or if your hair loss is extensive, you are more predisposed to a worsening of the outcome. But it is difficult to predict the evolution of this condition, due to the numerous factors it involves.
This largely depends on how extensive your hair loss has become. If instead of a single small bald patch, you now have two, you still have a good chance of regrowing hair spontaneously. However, if it has progressed to over 50% of your scalp, your baldness is less likely to resolve without treatment.
However, even if it’s a rarer occurrence, even people with extensive or full-body alopecia areata have been known to experience spontaneous remission.
No, Finasteride won’t work for your hair loss unless you are also experiencing androgenetic alopecia at the same time as alopecia areata. That is because it works for male pattern baldness by reducing the amount of a male hormone called dihydrotestosterone (DHT) in your blood.
Excessive amounts of this hormone bind to androgen receptors in the hair follicles of people with androgenetic alopecia, preventing them from producing new strands. But alopecia areata is not caused by excessive DHT, but by an autoimmune reaction which Finasteride does not influence.
Yes, this type of hair loss is known for its rapid progression. You can develop new bald spots in days and they can progress to full baldness in weeks. That is why it is recommended to see a trichologist the moment you notice changes in your hair loss pattern.
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