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Ophiasis Alopecia: Causes, Symptoms and Treatments
Dr Kieran Dayah (GMC)
Medically reviewed by
Dr Kieran Dayah (GMC)
Updated on June 9, 2024

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 [2]. However, if your hair is shedding in a snake-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 [3], so it should not lead to any physical discomfort, such as itching, tenderness or a burning sensation on your scalp.

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 spontaneously go into remission after a while, relapses are usually to be expected [2]. 

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
Patient with ophiasis alopecia

What is 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.) [5] 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 [6]. Since this usually occurs on an area of your scalp known as occipital, it is sometimes referred to as occipital alopecia.

A systematic review of 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% develop ophiasis alopecia [7]. 

Ophiasis alopecia is most frequently seen in children and infants, often developing before the onset of puberty. However, adults can also experience this condition [7][3]. 

What causes ophiasis alopecia?

The causes of alopecia areata are not yet fully understood. However, most researchers believe it is an autoimmune condition [3], 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).

Symptoms of ophiasis alopecia

What are the symptoms of ophiasis alopecia?

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 [3]. 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) [3].
  • Barely visible, miniaturised hairs [9] 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 [10]

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 on the back of the head
Traction alopecia on the back of the head [12]

Traction alopecia is a condition that develops from frequently wearing tight hairstyles, or heavy hair extensions, which cause hair loss by pulling on the 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 [11].

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 of 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, hair regrowth is rarely permanent, and you may expect the condition to relapse after a while [3].

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.  

Man getting treatment for alopecia

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 certain ophiasis alopecia patients, but it must be kept in mind that this form is often resistant to medication, such as [6] [13]:

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 procedure involves collecting blood from the patient, processing it to separate out 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 [14]. 

Hair regrowth in ophiasis alopecia after PRP treatment
Hair regrowth achieved in a patient with ophiasis alopecia after 3 months of PRP therapy [14]


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. 

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

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

What are other rare types of alopecia areata?

Besides ophiasis alopecia, there are some other rare forms of alopecia areata, which have specific manifestations [15][16][17]:

alopecia universalis
Alopecia totalis
  • Alopecia totalis involves losing all (or almost all) the hair on your scalp. 
Alopecia incognita
  • Alopecia incognita (diffuse alopecia) – consists of diffuse thinning with a positive pull test and hair miniaturisation. 
Alopecia sisaipho
  • Alopecia sisaipho – it 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 – it consists of an acute episode of diffuse alopecia accompanied by sudden hair greying.
Getting support for ophiasis alopecia

Getting support for ophiasis alopecia

Any type of hair loss can cause significant anxiety and distress. However, treatment-resistant forms such as ophiasis alopecia can be particularly frustrating, and they can chip away at your self-esteem. If you or a loved one are experiencing this condition, you should know support is available. Consider the following options to help you cope with your alopecia:

Join a support group

There are many online and offline communities built to provide mutual support for people who experience alopecia areata. It can be very helpful to encounter other people who share your struggles, listen to their stories and share yours with them. They can also provide insight into their own coping strategies, which may be helpful in dealing with your own condition. You can find a UK alopecia areata support group here.

Talk to a mental health professional

Hair loss has been connected to increased levels of anxiety, depression, low self-esteem, feelings of shame and anger and social withdrawal. It can significantly affect your personal, social and even professional life [21]. So, if you are experiencing a persistent low mood or negative emotions in relation to your alopecia, do not hesitate to see a psychologist. They can help you develop healthy coping strategies. And, should your distress become more severe, they can refer you to get a prescription for antidepressants or anti-anxiety medication, as needed.  

Open up to your loved ones

It isn’t easy to share our emotions regarding aspects of ourselves that make us feel embarrassed or insecure.  However, those who love you will be there for you regardless of your physical appearance and the state of your hair. If you feel comfortable doing so, opening up to friends and family about the difficult feelings your hair loss is causing you can make you feel heard and supported. And it gives them a chance to be there for you and show you that your value extends far beyond your scalp and hair.   

Child ophiasis alopecia
Child with ophiasis alopecia [22]

How to talk to your child about ophiasis alopecia

It can be difficult for children to understand why their hair is falling off and they may be facing bullying or social exclusion because of it. And if you are the parent of a child with alopecia, you may feel distraught and powerless to help them. However, there are some things you can try to help them gain a better understanding of their condition and build their self-esteem:

  • Break down what is happening to their hair and scalp in simple, age-appropriate terms. You can find some helpful guides explaining alopecia areata to children of different ages here
  • Be gentle, but honest about what they can expect – the temptation can be high to tell them that their hair will grow back soon, but that is not a certainty and your child may feel disappointed and deceived if it does not. It is better to maintain hope by telling them there is a good chance it will happen but to help them cope in the meantime.
  • Help them pick out hairstyles and accessories that can cover up their hair loss. If appropriate, let them choose the options they are most comfortable with, even if you might prefer differently.
  • If your child enjoys that, read books or watch movies together about children who are bullied for their appearance but overcome adversity. For example, R.J. Palacio’s book “Wonder” is an excellent option and it also has an inspiring film adaptation.
  • Work with your child’s school to educate his classmates about alopecia, curb bullying, and encourage social inclusion. 
  • If your child shows signs of persistent distress regarding their hair loss, seeing a pediatric mental health specialist can be of significant help. A child therapist can help them develop healthy coping mechanisms and raise their self-esteem and self-confidence.      

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 should 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 June 9, 2024
The Wimpole Clinic offers FUE Hair, Beard & Eyebrow Transplants & Trichology.
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