Alopecia Areata: What It Is and What Actually Helps

Alopecia areata is not the same as regular hair loss.

If you've noticed one or more smooth, round bald patches appearing suddenly on your scalp — or elsewhere on your body — you may be dealing with alopecia areata. It's an autoimmune condition, not a nutritional deficiency or hormonal issue, and it needs to be understood and treated differently.

Here's what you need to know. And if you're not sure which type of hair loss you're dealing with, our Complete Guide to Hair Loss in South Africa can help you identify the cause before you start treatment.

What is alopecia areata?

Alopecia areata is an autoimmune condition in which the immune system mistakenly attacks the hair follicles, causing them to stop producing hair. It's not contagious, it's not caused by stress alone (though stress can trigger flares), and it's not a sign of poor health or hygiene.

It affects approximately 2% of the global population at some point in their lives — making it one of the most common autoimmune conditions in the world. It can affect anyone, at any age, regardless of gender or ethnicity.

What does alopecia areata look like?

The most recognisable sign is one or more smooth, round or oval bald patches on the scalp. The skin in the affected area typically looks completely normal — no redness, no scaling, no scarring. The patches can appear suddenly, sometimes overnight.

Other signs include:

• Exclamation mark hairs — short hairs that are narrower at the base, found at the edges of patches
• Nail changes — pitting, ridging, or brittleness of the nails (present in some cases)
• Hair loss in other areas — eyebrows, eyelashes, beard, or body hair

In more extensive cases:

• Alopecia totalis — complete loss of scalp hair
• Alopecia universalis — complete loss of all body hair

What causes alopecia areata?

The exact cause isn't fully understood, but it involves a combination of genetic predisposition and immune system dysfunction. The immune system attacks the follicles as if they were foreign tissue, disrupting the hair growth cycle.

Triggers that can initiate or worsen flares include:

• Significant emotional or physical stress
• Illness or infection
• Hormonal changes
• Other autoimmune conditions (thyroid disease, vitiligo, and type 1 diabetes are more common in people with alopecia areata)

Importantly: alopecia areata does not scar the follicle. The follicle remains alive and capable of producing hair — which is why spontaneous regrowth is possible.

Will the hair grow back?

In many cases, yes — but it's unpredictable.

Around 50% of people with mild alopecia areata (one or a few patches) experience spontaneous regrowth within 12 months, even without treatment. However, the condition is chronic and relapsing — patches can return, and in some people the condition progresses.

People with more extensive loss, a longer duration of patches, or a family history of alopecia areata tend to have a less predictable prognosis.

What treatments actually help?

Alopecia areata is a medical condition — treatment should be guided by a dermatologist. Here's an honest overview of the options:

Corticosteroid injections
The most common first-line treatment for patchy alopecia areata. Corticosteroids are injected directly into the bald patches to suppress the local immune response. Many people see regrowth within 4–8 weeks. Requires repeat treatments and is most effective for limited patches.

Topical corticosteroids
Applied directly to the scalp. Less effective than injections but useful for mild cases or as a maintenance treatment. Available as creams, foams, or solutions.

Minoxidil
Doesn't address the autoimmune cause, but can help stimulate regrowth in follicles that are still active. Often used alongside corticosteroid treatment rather than as a standalone therapy.

JAK inhibitors (baricitinib, ritlecitinib)
A newer class of oral medications that have shown significant results in clinical trials for moderate to severe alopecia areata. Ritlecitinib (Litfulo) received FDA approval in 2023 specifically for alopecia areata. These are prescription medications with potential side effects — discuss with a dermatologist.

Contact immunotherapy (DPCP)
A specialist treatment where a chemical is applied to the scalp to deliberately trigger an immune response, which can redirect the immune system away from attacking follicles. Effective in some cases but requires specialist administration.

What doesn't work: Standard hair loss shampoos and serums are not effective treatments for alopecia areata. They can support scalp health, but they don't address the autoimmune mechanism driving the condition.

Living with alopecia areata

Alopecia areata can have a significant emotional impact. The unpredictability of the condition — not knowing if patches will grow back or spread — is genuinely difficult to live with.

Practical support options include:

• Scalp micropigmentation or hairpieces for cosmetic coverage
• Support groups and communities (Alopecia SA is a South African resource)
• Psychological support — particularly if the condition is affecting mental health

Our recommendation at Partners Hair

If you suspect alopecia areata, see a dermatologist for a proper diagnosis before starting any treatment. Our stylists are experienced in working sensitively with clients experiencing hair loss — we can advise on styling approaches and scalp care that support your confidence while you navigate treatment.

Frequently Asked Questions

Is alopecia areata permanent?

Not necessarily. The follicles remain alive and capable of producing hair. Many people experience spontaneous regrowth, though the condition can relapse. More extensive cases have a less predictable outlook.

What triggers alopecia areata?

Stress, illness, hormonal changes, and other autoimmune conditions can trigger or worsen flares. However, the underlying predisposition is genetic — triggers don't cause the condition, they can activate it in people who are already susceptible.

Is alopecia areata the same as alopecia?

No — alopecia is a broad term for any type of hair loss. Alopecia areata is a specific autoimmune condition causing patchy hair loss. Other types include androgenetic alopecia (genetic pattern loss), traction alopecia (from tension), and telogen effluvium (stress-related shedding).

Can stress cause alopecia areata?

Stress can trigger flares in people who are genetically predisposed to alopecia areata, but stress alone doesn't cause the condition. The autoimmune mechanism is the underlying driver.

Where can I get help for alopecia areata in South Africa?

See a dermatologist for diagnosis and treatment. For scalp care, styling support, and product advice, book a consultation at Partners Hair — available in our salons across South Africa.