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Patches with no hair
Alopecia areata: round, smooth areas appearing within weeks, different from common baldness.
Alopecia areata does not resemble the progressive thinning people mean when they say «I am losing my hair». Here one or more round, sharply defined, completely smooth patches appear, often within a few weeks and often discovered by chance — at the hairdresser, or by someone who notices from behind. The underlying scalp is normal: not red, not scaling, not scarred.
The mechanism is immune: the immune system attacks the follicle, interrupting its cycle. The follicle, however, remains alive, and this is the difference that matters most compared with scarring forms: regrowth is possible, sometimes spontaneous, and the returning hairs may at first be fine or white before becoming normal again.
What the patient cannot judge alone is whether the patch really is alopecia areata or something else. Scalp ringworm, traction from hairstyles, lichen planopilaris also produce areas without hair, but have very different courses and consequences — and in at least one of them delay costs follicles. That is why the patch should be examined, not photographed weekly in the hope it passes.
The follicle is alive: that is the difference that changes everything
In scarring alopecias the follicle is destroyed and what is lost does not return. In alopecia areata the follicle stays in place, silenced: this is why regrowth is possible and why the goal is not to «save» something before it is too late. That holds if the diagnosis is right, though, and telling an areata patch from a scarring one is not done by eye in the bathroom mirror: it is done by examining the scalp under magnification, where the presence or absence of follicular openings can be seen.
How it shows
- One or more round, sharply defined patches with no hair
- Smooth scalp, not red and not scaling
- Rapid onset, often noticed by others
- Possible involvement of beard, eyebrows or eyelashes
- Sometimes pitting changes in the nails
- Initial regrowth with fine or white hairs
How we proceed
- 1Trichology visit: appearance of the patch, margins, condition of the scalp
- 2Examination under magnification to distinguish it from scarring forms
- 3Check of beard, eyebrows and nails, even if not reported
- 4Planning based on number, extent and duration
- 5Scheduled follow-up to monitor regrowth
Available treatments
- Trichology visit
- Magnified scalp examination
- Personalised pathway
- Scheduled follow-up
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Frequently asked questions
Is it caused by stress?+
Stress is blamed almost every time, and the honest answer is that it can be one factor among others, not the explanation. Alopecia areata has an immune basis and a predisposing component: attributing it entirely to a difficult period leads to two wrong consequences — feeling responsible, and postponing the visit waiting for «the stress to pass». The difficult period can be described at the visit, but it does not replace assessment.
Will the hair grow back?+
The follicle is not destroyed, so regrowth is possible and in a proportion of cases happens spontaneously. That said, the course is variable and unpredictable: there are single episodes that resolve and forms that recur over time. Promising a certain outcome would be wrong; what can be done is to assess the case properly and follow it, because the number and extent of patches guide more than any generic prediction.
How do I tell it from ordinary baldness?+
By shape and timing. Common baldness is progressive, symmetrical and follows typical sites — temples, crown — with hairs thinning before disappearing. Areata gives round, sharply defined patches within weeks, at any site, with smooth skin inside the patch. They are two different stories, and the pathways differ too: which is why the distinction is the first thing done at the visit.
Related reading
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