Circumscribed hair loss

What exactly is circumscribed hair loss?

So-called alopecia areata or circumscribed hair loss is made up of the Greek word alopekia meaning "pathological hair loss" and the Latin word area meaning "free space". Put simply, the term describes the presence of several circular bald areas, mostly affecting the scalp. However, in principle, it can occur on all hairy parts of the body.

One typical feature of circular hair loss is that inflammatory processes can be detected in these areas. This is known as follicular inflammation, since it involves structures surrounding the hair follicles. Alopecia areata is among the non-scarring forms of hair loss. In other words, the hair roots are not destroyed and it is possible for the hair to grow back again. 

The hair loss begins abruptly and has a very variable course. About 20% of the cases the hair loss is persistent, but most of the time it recovers. Very frequently, however, patients experience recurrences, which means that the disease comes back.

Also the degree of hair loss can differ, so different forms can be distinguished from one another.

Alopecia areata can affect all genders and ages. It is most common in children between the ages of 3 and 12 as well as in young adults.

Can alopecia areata affect the beard and eyebrows?

Although alopecia areata most frequently occurs on the scalp, in principle, it can affect the entire body hair. Therefore, it can also arise in the areas of beard, eyebrows or pubic hair, for example. This particular form is also referred to medically as alopecia areata universalis.

What causes alopecia areata?

The suspected cause of circumscribed hair loss are autoimmune reactions. In simple terms, the disease is caused by a disorder of the immune system. Your body produces antibodies against its own structures and triggers an inflammation. In this case, the defense mechanisms are aimed at the hair follicles, which are not damaged, but are prevented from growing.

About 20% of the cases show a familial incidence, and a possible connection with stress is discussed in medical research.

How is this form of hair loss diagnosed by the specialist?

To diagnose alopecia areata, the hair specialist will first obtain a detailed medical history and evaluate the individual clinical appearance. For a more advanced diagnosis and hair analysis of hair loss, the doctor can also collect a sample from the hairless areas and examine it under the microscope. This may visualize the inflammatory processes which are taking place. 

What therapy and treatment options are available?

At present, it is not possible to treat the cause of alopecia areata. Consequently, the treatment options mainly target the symptom relief of the disease, that is to fight the hair loss. Hence, following withdrawal of the therapy, hair loss may often recur. A cosmetic treatment option is hair pigmentation.    

The therapies currently used are mainly directed against the inflammatory reaction taking place in the hairless areas. They involve the use of anti-inflammatory drugs, which often represent the treatment of choice. These are primarily medications containing cortisone, which are either taken orally as tablets or administered locally in the form of ointments or hair lotions.

An alternative therapy approach is to provoke an inflammation in the affected areas. The body's defense mechanisms will respond by focussing on the induced inflammation, so that the the attack against the hair roots is toned down. For instance, the affected skin can be treated with liquid nitrogen or irradiated with UV-A light as part of the so-called PUVA therapy.

Immunotherapy or PRP therapy for hair loss can also be beneficial in certain instances. They are methods that boost the body's own immune system in a way that makes it easier to fight a disease. 

Can vaccinations (e.g. against COVID) be the cause of alopecia areata?

In some cases, circumscribed hair loss was observed after an infection with Corona. This was also found in a small amount patients after receiving the Corona vaccination.

However, currently there isn’t sufficient evidence pointing to an association between alopecia areata and another vaccine.

Can hair loss be caused by the thyroid gland?

Your thyroid gland influences many processes in your body. A thyroid gland that is stunted in its activity, medically referred to as hypothyroidism, can influence hair growth. It can make the hair brittle and even cause it to fall out. In some cases, a thyroid disorder occurs in connection with circumscribed hair loss.

Which doctors & clinics specialize in alopecia areata?

Even though alopecia areata does not cause any physical pain, it may be associated with a significant psychological burden for the affected person. It is therefore important to find a competent specialist who can discuss the numerous treatment options with the patient.

When it comes to hair loss, dermatologists are often the initial go-to expert, although not every dermatologist has experience in dealing with alopecia areata. It is therefore recommended to consult a proper specialist.

Let us help you find the right specialist for this specific condition. The doctors we propose have been reviewed by us under strict criteriae and all have a great amount of experience in the field of alopecia areata. Please feel free to benefit from their experience and simply schedule an initial interview with one of our experts.