Baldness in patches, which is not in the typical male pattern, is usually alopecia areata. However, braiding and other tight hairstyles, hair pulling and fungal infection also cause bald patches.

Alopecia areata occurs in about 3% of people and affects men and women equally. It can occur at any age, but in most people it occurs between the ages of 5 and 40 years. The cause is not known. Most experts think it is an auto-immune condition, in which the body’s immune system attacks the hair follicles by mistake. It is slightly more common in people with thyroid disease. There may be a link with stressful life events. About 1 in 5 people with alopecia areata says that other family members have the same problem, so genes are important.

The hair is lost completely from the patch, leaving a smooth, shiny scalp. A magnifying glass shows that the openings of the hair follicles are still present, but there are no hairs protruding from them. There may be short, distorted hairs at the edge of the bald patch. There may be only one patch, or there may be several. Sometimes there is a more diffuse appearance, rather than distinct patches.

Alopecia areata can be very distressing, but the good news is that the hair follicles are not permanently damaged, so regrowth of hair usually occurs. Regrowth is unpredictable, but usually occurs in 6–9 months. At first the new hair may be white, but after 12–18 months the colour returns to normal. In some people the problem recurs after a few years.

Rates of regrowth:

  • 40% of patients with a single patch of hair loss have full hair regrowth within 6 months.
  • 27% of patients with multiple patches of hair loss have full regrowth within 12 months.
  • 33% of patients with alopecia areata have chronic hair loss.

In about 1 in 20 people with alopecia areata, the hair loss continues, so there will be total hair loss.

  • In a few people, regrowth can be temporarily encouraged with minoxidil lotion solution, but the effect lasts only while the lotion is being used.
  • Some doctors inject steroids into the scalp or prescribe steroid creams, but these only occasionally result in some regrowth and hair often falls out after treatment stops (MIMS Dermatology 2007;3:51).
  • Dithranol is a cream or paste made from tar and is used mainly to treat the skin disease psoriasis. In some people it produces some regrowth of hair. It is rubbed into the scalp and washed off after a few hours. Dithranol is messy, and stains clothing.
  • Essential oils may help, according to research at Aberdeen Royal Infirmary, Scotland (Archives of Dermatology 1998;134:1349–1352). Patients massaged a combination of thyme, rosemary, lavender and cedar wood oils into their scalps at night, and then wrapped a warm towel around the head to encourage the oils to soak in. After a few months, 44% had growth of hair (compared with 15% of those using dummy oils).

Braiding and other tight hairstyles. Some hairstyles, such as braiding and corn-rows, pull the hair very tightly. This can result in a bald area, usually at the hairline around the forehead. If you give up this kind of hairstyle, the scalp usually recovers and the hair will grow normally, but the area can remain permanently bald.

Hair pulling. Children quite commonly develop a habit of pulling the hair; there will be a patch of hair loss with stubbly regrowth. Adults (particularly women) can develop a similar habit, which becomes a psychological compulsion and is hard to stop.

Fungal infection. In children, a bald patch may represent fungal infection. The bald area usually looks red and scaly. After the fungal infection is treated, the hair will grow again.

Other diseases. Some other diseases, such as systemic lupus erythematosus (SLE) and sarcoid, can cause bald patches. These often have a discoloured and scarred appearance. They can also affect the face and ears commonly. It is worth discussing the problem with your doctor.


First published on:
Reviewed and edited by: Dr Ahmed Kazmi
Last updated: October 2020

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