Alopecia areata: The Many Forms of "Total Baldness"

Total Loss of Scalp Hair in AA: Not one Type

Alopecia areata is an autoimmune condition. The cause is not fully known but genetics play a very important role. In fact, at least 70 % of the disease can be explained by a person's genetic make up. I often tell my own patients that the tendency for them to actually develop this condition was inside them from the day they were born (technically speaking it is the day they were conceived). Alopecia areata can cause hair loss in patches on the scalp or total hair loss.

Variations in AA

There are many many different variations. Even patients who have no hair on the scalp are of two main groups: 1) patients with smooth scalps totally devoid of any visible hair follicles and 2) patients who are completely bald but have many broken hairs (called black dots) all over the surface. This second form has much better prognosis (chances for regrowth) although complete hair loss in alopecia areata is still quite challenging to treat overall. This photo shows a patient who at a distance would appear to have no hair on the scalp. A closer examination shows that the scalp actually has many hairs - it is simply that they are broken at the surface. One hair has managed to grow but inflammation beneath the scalp has caused it to break off a few millimetres above the surface. This is called an "exclamation mark" hair.