Alopecia areata affects 2% of the worldwide population and 1 in 170 people in the UK [1-2]. For those affected, alopecia areata can feel highly noticeable, especially if it starts to spread across your scalp.
Fortunately, for more than half of those with alopecia areata, any bald patches clear up without treatment in less than a year [3]. But for others, it can actually get worse. 30% of people with alopecia areata go on to develop alopecia totalis (total loss of scalp hair) or alopecia universalis (total loss of body hair) [3].
So is there a way to stop alopecia areata from spreading? In recent years, the UK’s medical regulator has approved several new treatments for alopecia areata, including Oluminant and Litfulo. So there are more options than ever for controlling the spread of alopecia areata.
In this article, you’ll learn how to stop alopecia areata from spreading, including:
Alopecia areata is an autoimmune condition that causes small round bald patches to appear on your scalp and/or body. In this condition, your white blood cells attack your hair follicles, causing them to stop producing hair. Alopecia areata may also be influenced by genetics; around 9% of those who experience it have a family history of the condition (rising to 10-51% in children [2].
Many people with alopecia areata find that the condition flares up again in time, even after spontaneous remission. Researchers are still establishing what exactly causes alopecia areata to flare up and spread, but studies suggest it may involve:
Degree of inflammation – High levels of inflammation around the follicles can widen autoimmune bald patches. That’s why anti-inflammatory drugs can often help stop the spread of alopecia areata.
Emotional triggers – Stress and other emotional factors may trigger a flare up of alopecia areata [2]. Research suggests anxiety and depression can be both a cause and effect of alopecia areata [4].
Viral or bacterial infections – Illnesses such as viruses may also trigger an alopecia episode [5]. Infections cause your immune system to become more active, increasing inflammation.
Genetics – For some people, your genes may determine the extent of your alopecia areata. Look to other people in your family who have similar symptoms.
Smoking – Smoking increases the production of inflammatory cytokines in your body, which may trigger hair loss in those with this condition.
Nutritional deficiencies – Certain vitamin deficiencies have been linked with alopecia areata, so you may find flare-ups coinciding with periods of poor nutrition [6]. Alopecia areata flare-ups are also more common in autumn and winter, when sun exposure and vitamin D intake is lower [7].
Disturbed sleep – Not getting enough sleep may affect the activity of your immune system [8].
Obesity – There is an established link between obesity and inflammatory diseases. Being significantly overweight can affect the functioning of your immune system [9].
It’s worth noting that alopecia areata isn’t contagious, so you can’t catch it or pass it on to others.
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:
Other symptoms of this condition include short, broken hairs that look like exclamation marks, though this may be hard to see on your own scalp. You may also have pitted nails.
You can’t always tell if your alopecia areata is likely to spread. Each case is different, and not everyone has progressive alopecia areata. Up to half of all patients can recover within a year even without treatment. However, other research shows that approximately 30% of patients with this type of alopecia will progress to complete hair loss [3].
You’re more likely to have progressive or severe alopecia areata if [3]:
Sometimes, alopecia areata spreads by forming new bald spots. So monitor your entire scalp for the development of new patches of hair loss.
Other signs that your alopecia may be advancing may include:
Unfortunately it’s not always possible to stop alopecia areata from spreading. Some types of alopecia areata are resistant to all available treatments and will progress regardless of the preventative steps you take. This is more likely with more severe, less common types like alopecia ophiasis.
It’s hard to predict how your condition will evolve. But with more treatments becoming available, there are several solutions you can try to reduce the risk of your alopecia spreading.
While you may not always be able to stop your alopecia areata from progressing, there are many cases where the right treatment can help. Here, you’ll find 10 evidence-based ways to keep your alopecia areata under control.
While it can resolve on its own, it is still a good idea to see a trichologist when you see the first signs of hair thinning and balding. They can confirm your diagnosis, which is important as lopecia areata can be confused with other types of alopecia. This may be the case with certain scarring alopecias, trichotillomania or ringworm [3].
A trichologist can also recommend treatment that can curb your hair loss and perhaps prevent it from spreading.
Corticosteroids are among the most widely used and effective treatments for alopecia areata. They’re especially useful for treating children and younger people, as they generally have a good safety profile and are painless to administer [4].
Steroid creams for hair loss tend to work best on mild forms of patchy alopecia areata.
Intralesional steroid injections for hair loss may be even more effective than topical creams [11]. They tend to be very effective against mild to moderate forms of alopecia areata that affect less than 50% of your scalp.
One clinical trial compared the effects of triamcinolone hexacetonide and triamcinolone acetonide injections for alopecia areata. Clinicians found hair growth in 64% and 97% respectively, indicating success for both types of steroid [12].
Corticosteroid injections can be effective even against more advanced hair loss. Various studies report between 39% and 86% hair regrowth in patients with moderate to extensive alopecia areata, depending on the extent of their condition and the type of steroid used [13].
Up to 60% of patients with severe forms of this condition (50%-99% hair loss) may see improvements with steroid injection treatment [14].
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 [15]. Only 6-14% of patients with severe forms of this condition treated with Minoxidil 5% showed significant hair regrowth [16].
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 [17].
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.
Contact immunotherapy is often used to treat alopecia areata, especially if it’s already started to spread [3]. This treatment works by exposing you to weak allergen, known as a contact sensitiser. This induces a mild allergic reaction known as contact dermatitis. The allergen is then applied to your patches of alopecia on a regular basis.
This reaction 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]:
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 and the UK Medicines and Healthcare products Regulatory Agency licensed Olumiant, or baricitinib, as the first JAK inhibitor to treat alopecia areata.
Since then, another JAK inhibitor known as Litfulo (ritlecitinib) has also been approved to help stop alopecia areata from spreading.
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 and/or 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.
Studies show that efficiency levels of LLLT for alopecia areata are comparable to those of intralesional corticosteroids: 36.9-100% efficiency with 50% or greater hair regrowth [23]. (Bear in mind, however, that these results are based on relatively small studies, including 94 participants over 8 clinical trials.)
Smoking causes hair loss, among other (some very serious) health problems. It has been linked with higher incidences of alopecia areata and can trigger flare-ups in some people [24].
Nicotine promotes inflammation in your body, including your scalp. It also constricts your blood vessels, which allows less blood flow (and therefore fewer nutrients) to your hair follicles.
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 may compound the effects of other genetic, biological and environmental factors.
Some vitamin deficiencies can cause hair loss, including triggering or worsening your alopecia areata. For example, vitamin D deficiency has been linked to the development, flaring or spreading of this condition [25].
Your hair follicles need a variety of nutrients to produce healthy hair. This is even more important when they are under attack by your immune system. So ensure your diet provides all the vitamins, minerals and protein required 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 (such as nuts, seeds, and leafy greens).
There are many connections between stress, anxiety and hair loss. Studies have found significant links between the triggering or worsening of alopecia areata and stressful life events. In one study, 46% of alopecia areata patients reported having experienced family problems, while 36% had experienced personal problems before the onset of their condition or a flare up [26].
Stress alone is unlikely to cause your alopecia areata. But it can trigger hair loss when it overlaps with other triggers, so it’s important to take care of your mental health to prevent alopecia areata from spreading.
Develop a healthy self-care routine that allows you to unwind and recharge your psychological batteries. Active relaxation can help. This may include strolling in nature, practising meditation, exercising, engaging in entertaining hobbies or spending quality time with your loved ones.
One study found that using a specific combination of essential oils for hair growth could help treat alopecia areata [27]. Applying a blend of thyme, rosemary, lavender and cedarwood essential oils in jojoba hair oil and grapeseed carrier oils for 7 months improved symptoms in 44% of the test group.
Another study found that onion juice may also help improve symptoms of alopecia areata [28]. 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). The best proven, natural ways to manage your alopecia areata include reducing stress, quitting smoking, and eating a balanced healthy hair diet.
Unfortunately, hair transplants for alopecia areata don’t usually work. And they definitely can’t help prevent this condition from spreading.
In this condition, your hair follicles are not permanently damaged. It’s possible for you to go into spontaneous remission at any point, indicating that the hair roots are still intact and able to produce new hair under the right circumstances. So there’s no benefit in transplanting other follicles, which may also be impaired by your immune system.
Hair transplants have been successfully performed on alopecia areata patients whose condition has been stable for at least 2 years. That means it has not improved but has not spread either. But this is rare, and most hair transplant surgeons are unlikely to recommend this procedure for those with alopecia areata.
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 [29]. 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 [30]:
It is natural to be worried about the progression of your alopecia areata. But support is out there – with the right treatment, you may be able to stop your alopecia areata from spreading within just a few months.
At the Wimpole Clinic, our hair loss specialists can help with all kinds of hair concerns. Book a consultation with one of our experienced trichologists at your most convenient clinic location. There, we’ll provide you with a thorough and complete assessment of your scalp condition and recommend the most effective, personalised treatments to curb your alopecia areata.
Find out even more about alopecia areata and how to treat it in the answers to these frequently asked questions.
No, not always. While in some people, alopecia areata may spread, this doesn’t happen in most cases. Instead, most people tend to have semi-regular flare ups that resolve themselves in a few months to a year.
If your alopecia flare lasts for several years or you have extensive hair loss, your condition is more likely to spread. 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 hormone called dihydrotestosterone (DHT) in your blood.
Excessive amounts of this hormone bind to androgen receptors in the follicles of people with androgenetic alopecia, preventing them from producing new hair. 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.
Some of the alopecia areata treatments listed here are suitable for children. Steroid creams, in particular, are commonly used to treat alopecia areata in children. Your GP can signpost you to useful resources for treatment and emotional support.
Alopecia areata can be very difficult for children, who may receive unwanted attention from their peers as a result. So they may need you to provide a lot of emotional support and reassurance while they navigate this condition. It’s also a good idea to discuss it with your child’s teacher(s) so they can provide support where needed.
Alopecia UK also provides excellent resources for children and young people experiencing hair loss.
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