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Ophiasis Alopecia: Causes, Symptoms and Treatments
Dr Kieran Dayah (GMC)
Medically reviewed by
Dr Kieran Dayah (GMC)
Updated on December 23, 2023

Ophiasis alopecia is probably not the first condition that comes to your mind if you are experiencing hair loss. That is because this rare type of alopecia areata only affects 0.02% of the population [1].

However, if your hair is shedding in a band-like pattern on the back of your head and around your ears, you may want to consider this possibility. Although it is more common in children, adults can also develop it.  

The good news is that ophiasis alopecia does not normally cause inflammation [2], so it should not lead to any physical discomfort, such as itching, a burning sensation on your scalp or scalp tenderness in one spot.

Unfortunately, the prognosis for ophiasis alopecia is also poorer than for other forms of alopecia areata. It is often resistant to treatment and while, in some cases, it can go into remission spontaneously after a while, relapses are usually to be expected [1]. 

Keep reading this article to find out all you need to know about:

  • What ophiasis alopecia is
  • What causes ophiasis alopecia
  • The main symptoms of ophiasis alopecia
  • The most effective treatment for ophiasis alopecia
  • Other uncommon types of alopecia areata 
Table of Contents

What is ophiasis alopecia?

person with ophiasis alopecia

Ophiasis alopecia is a rare form of alopecia areata. Under its most common presentation, alopecia areata manifests as smooth, round, patchy bald spots on any part of your body which is covered with hair (scalp, beard, eyebrows, etc.) [3] However, rare variations of this condition can manifest differently. 

Ophiasis alopecia is named after the Greek word for “snake” – ophis. That is because it creates a bald band on the back of your head which may sometimes be straight but is usually wavy [4]. Since this usually occurs on an area of your scalp known as occipital, it is sometimes referred to as occipital alopecia.

A systematic review performed on 94 studies about alopecia areata and its varieties, including a total research population of over 300 million people, revealed that while 2.11% of all people experience alopecia areata, only 0.02% of people develop ophiasis alopecia [5]. 

Ophiasis alopecia is known to occur most frequently in children and infants, often developing before the onset of puberty. However, adults can also experience this condition [5][2]. 

What causes ophiasis alopecia?

The causes of alopecia areata are not yet fully understood. However, most researchers believe that it is an autoimmune condition [2], which means your white blood cells are attacking your hair follicles, mistaking them for harmful entities. This damages your hair follicles, making them temporarily or permanently unable to produce hair. 

Since ophiasis alopecia is a form of alopecia areata, it is likely caused by an autoimmune response which attacks the hair on the back of your scalp and the area around your ears (and, in very rare cases, the hairline).

What are the symptoms of alopecia ophiasis?

There are not many symptoms of alopecia ophiasis aside from the tell-tale bald band at the back of your head. You should not experience any discomfort, scalp irritation or inflammation alongside it [2]. Normally, you may notice the following:

  • A smooth, wavy bald band, usually 2.5 – 8 cm in length, on the back of your scalp and/or around your ears (very rarely, at the front of your scalp) [2]. 
  • Barely visible, miniaturised hairs [6] that look like exclamation marks
  • Yellow, white or black dots on the scalp  
  • Nail changes (such as pitting or longitudinal ridging) have been observed in some patients with ophiasis alopecia, but at a much lower rate than in patients with the most common form of alopecia areata [7]  

What can ophiasis alopecia be mistaken for?

On rare occasions, ophiasis alopecia can be mistaken for a different condition which causes hair loss, called traction alopecia.

Traction alopecia is a condition which develops from frequently wearing tight hairstyles, or heavy hair extensions which cause hair loss by pulling on your hair root. While it often occurs in the front and sides of your head (as that is where most of the tension is with hairdos such as braids, buns or ponytails which cause hair loss), it can form on any part of your scalp where the hair has experienced tension [8].

Here are some guidelines to help you tell if it’s traction alopecia or ophiasis alopecia:

Traction alopeciaOphiasis alopecia
Usually around the front of your head and templesUsually around the back or your head and around your ears
Irregularly shaped balding patches, depending on the amount of tension appliedA regular band of hair loss
Small skin-coloured bumps at the roots of your hairYellow, white or black dots on the scalp
Sometimes, itching, irritation, scaling and inflammation of the balding area.No scalp discomfort or discolouration in the balding area.
Is usually resolved by avoiding tight hairdos and heavy extensions.It sometimes resolves spontaneously, but will often recur. Does not usually respond well to treatment.

How long does ophiasis alopecia last?

Ophiasis alopecia will sometimes resolve on its own, with no treatment, after approximately 15-20 months. However, the hair regrowth is rarely permanent and you may expect the condition to relapse after a while [2].

Sometimes, some hair regrowth can be achieved with medication. In other situations, ophiasis alopecia can be lifelong, since there is no known cure and it is often resistant to treatment.  

What is the treatment for ophiasis alopecia?

While there are currently no treatments available that can cure ophiasis alopecia, there are some medications and therapies which can improve the symptoms of the condition and achieve some hair regrowth in certain patients. 

Common treatments for alopecia areata may lead to some symptom improvement in ophiasis alopecia patients, but it must be kept in mind that this form is often resistant to medication, such as [4] [9]:

People with ophiasis alopecia are also not normally considered good candidates for a hair transplant, as hair transplants for alopecia areata don’t often work. That is because the new hair grafts would also be attacked by your immune system. 

Some of the therapies which have shown promising results in certain people who experience ophiasis alopecia include:

Platelet-rich plasma (PRP) therapy 

This is a procedure that involves collecting blood from the patient, processing it to separate the blood components called platelets and then reinjecting the platelets into the affected area of the patient’s scalp. This triggers the body’s natural healing response and stimulates hair follicles for hair growth.

One study found this treatment efficient in stimulating hair growth in a patient with this condition after 3 months of use. The patient had previously not responded to treatments with Minoxidil and topical steroids [10]. 

patient before and after PRP therapy for ophiasis alopecia
Hair regrowth achieved in patient with ophiasis alopecia after 3 months of PRP therapy [10]


Also known as derma rolling for hair growth, microneedling is a therapy which uses a tool called a derma roller to create microscopic punctures in the scalp, triggering your body’s natural healing reaction and helping hair growth medicine achieve better skin penetration. 

This property of increasing skin penetration has likely helped a patient with ophiasis alopecia respond and achieve some hair growth after undergoing microneedling alongside treatment with topical corticosteroids for 6 months [4]. 

hair regrowth before and after microneedling and steroid treatment
Hair regrowth achieved in a patient with ophiasis alopecia after 6 months of combined treatment with microneedling and topical corticosteroids [4]

What are other rare types of alopecia areata?

Besides ophiasis alopecia, there are some other rare forms of alopecia areata, which have specific manifestations [11][12][13]:

alopecia universalis

|This type of alopecia is characterised by losing hair on the entirety of your body.   

Alopecia totalis

This hair loss condition involves losing all (or almost all) the hair on your scalp. 

Alopecia incognita (diffuse alopecia)

Alopecia incognita

Alopecia incognita consists of diffuse thinning with a positive pull test and hair miniaturisation.

Alopecia sisaipho

Alopecia sisaipho

Alopecia sisaipho is named by spelling “ophiasis” backwards, as it is considered a reverse of ophiasis alopecia. It involves hair loss everywhere on the scalp except the outer regions of the scalp. 

Marie Antoinette Syndrome

Marie Antoinette Syndrome

Marie Antoinette Syndrome consists of an acute episode of diffuse alopecia accompanied by sudden hair greying.

Are you concerned you may have ophiasis alopecia?

If you suspect that you may be experiencing ophiasis alopecia, it is best to book a consultation with one of our top trichologists from the first signs of hair thinning and balding. They will examine your scalp, perhaps conduct some tests, and provide you with an accurate diagnosis.

Moreover, they will be able to provide personalised treatment recommendations which may help manage your symptoms and restore some hair growth.

And even if your condition will not respond well to treatment, they will still be able to provide you with helpful tips and tricks to make the best out of the situation, such as showing you the best ways to hide your hair thinning.

Ophiasis Alopecia: Causes, Symptoms and Treatments, Wimpole Clinic

Dr Kieran Dayah (GMC)
Medically reviewed by Dr Kieran Dayah (GMC)Updated on December 23, 2023
The Wimpole Clinic offers FUE Hair, Beard & Eyebrow Transplants & Trichology.
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