Brief overview
- Prognosis: The hair often grows back on its own, but relapses often occur and the circular hair loss becomes chronic.
- Causes: Presumably an autoimmune reaction in which the body’s own defense cells attack the hair follicles and trigger an inflammatory reaction.
- When to see a doctor: If there is increased hair loss with noticeably round, bald patches, a visit to the doctor is recommended.
- Diagnosis: Medical history, examination of the scalp (e.g. with a dermatoscope) and, if necessary, the hair roots (trichogram)
- Treatment: creams with skin-irritating (anthralin, dithranol) or circulation-promoting (minoxidil) substances, cortisone therapy (as cream, injections, tablets or infusion), topical immunotherapy, photochemical therapy (PUVA)
What is circular hair loss?
Circular hair loss (alopecia areata) is an inflammatory form of hair loss that usually starts suddenly and without warning. Circular bald patches appear, which spread outwards from the center. The disease is not that rare: One to two out of every 100 people will develop circular hair loss in their lifetime. It usually occurs in young adults, but children also sometimes develop alopecia areata.
The severity varies: while most sufferers only develop small, limited hairless areas, others lose all of their scalp hair (alopecia totalis) or even all of their body hair (alopecia universalis). However, these forms are rare. A special form is alopecia ophiasis, in which the hair mainly falls out around the neck and temples.
How does circular hair loss progress in women and men?
The course of circular hair loss is unpredictable. In general, the prognosis is better in children than in adults. There is no difference in the course of the disease in men and women. However, many women suffer more psychologically from their altered appearance due to alopecia areata.
In many cases, circular hair loss heals unexpectedly on its own (spontaneously). The hair that grows back is initially very fine and colorless, but later it usually regains its usual thickness and color. Sometimes this spontaneous healing is permanent, but in other cases it is only temporary – the hair falls out again.
Overall, alopecia ophiasis is more often chronic than other forms of circular hair loss. In addition, the longer the disease has been present, the greater the likelihood of a chronic course.
When the hair grows back after treatment, it is usually pigmentless (white). Those affected then have patches of white hair on their head, which doctors refer to as poliosis. In some cases, a relapse occurs later and the hair falls out again.
Some sufferers eventually decide to wear a wig – especially if the circular hair loss affects the entire head.
What are the possible causes?
The cause of circular hair loss is not yet fully understood. Doctors suspect a disorder of the immune system, a so-called autoimmune reaction: due to a dysregulation, the body’s defense cells are directed against cells in the hair follicles. The result is an inflammatory reaction. The hair follicles themselves remain intact, but hair growth is disturbed and the hair eventually falls out.
This results in round, bald patches in the hair coat, usually on the head. However, circular hair loss sometimes also affects the beard, eyebrows and other body hair. In the most severe form, those affected lose all body hair (alopecia universalis).
A genetic predisposition also appears to play a role in circular hair loss; sometimes it occurs in families. In some cases, psychogenic (partial) causes can be identified: Occasionally, circular hair loss develops during stress, exams, after accidents or bereavement.
It is certain that circular hair loss is not the result of malnutrition (such as vitamin deficiency) or harmful environmental influences (environmental toxins).
When to see a doctor?
Hair loss as such is a common symptom that is triggered, for example, by hormonal changes, stressful situations, but also simply by ageing. However, if you notice that conspicuous round, bald patches are forming on the scalp or in the area of the body and facial hair, it is advisable to see a doctor – it may be circular hair loss.
The right person to contact if you suspect circular hair loss is your dermatologist or GP, who will issue an appropriate referral.
What does the doctor do?
A genetic predisposition also appears to play a role in circular hair loss; sometimes it occurs in families. In some cases, psychogenic (partial) causes can be identified: Occasionally, circular hair loss develops during stress, exams, after accidents or bereavement.
It is certain that circular hair loss is not the result of malnutrition (such as vitamin deficiency) or harmful environmental influences (environmental toxins).
When to see a doctor?
Hair loss as such is a common symptom that is triggered, for example, by hormonal changes, stressful situations, but also simply by ageing. However, if you notice that conspicuous round, bald patches are forming on the scalp or in the area of the body and facial hair, it is advisable to see a doctor – it may be circular hair loss.
The right person to contact if you suspect circular hair loss is your dermatologist or GP, who will issue an appropriate referral.
What does the doctor do?
Dithranol, which is also applied as an ointment (0.5 to two percent) to the affected areas, works in a similar way.
Other skin irritants that are sometimes used to treat circular hair loss are chrysarobin, capsaicin (pungent substance from chili peppers) and pepper tincture. However, they only actually make the hair grow back in individual cases.
Minoxidil against circular hair loss
Solutions containing the active ingredient minoxidil are actually approved for the external treatment of hereditary hair loss. It promotes hair growth by stimulating blood circulation around the hair follicles. Minoxidil is usually used in addition to other treatment methods (such as cortisone), as otherwise no resounding success can be expected with circular hair loss.
When treating alopecia areata in children, for example, a low-dose minoxidil solution is often used in combination with a medium-strength cortisone preparation.
Glucocorticoids (“cortisone”) against circular hair loss
Cortisone is therefore often injected into the bald patches of skin using small syringes. The doctor places these cortisone injections about one centimeter apart on the affected areas of skin. He proceeds carefully when injecting and observes the total dose of glucocorticoids injected. Otherwise, the active ingredient may enter the bloodstream in relevant quantities and thus trigger undesirable effects throughout the body (systemic side effects). However, it is often necessary to repeat the therapy every four to six weeks to achieve a lasting effect.
Systemic cortisone therapy – for example in the form of tablets – is only an option in severe, extensive cases of circular hair loss. It is true that in most patients it does actually make the hair grow back. However, cortisone must be taken long-term in a dosage that weakens the immune system and promotes water retention in the tissue (oedema) and menstrual disorders as side effects, for example.
Topical immunotherapy for circular hair loss
The effectiveness of local immunotherapy with the active ingredient diphencyprone (diphenylcyclopropenone, DPCP) for circular hair loss has been scientifically proven. However, this method is only used for larger bald patches.
First, the doctor applies a high concentration of the active ingredient to the bald patches with the aim of triggering inflammation and sensitizing the patient’s immune system to the active ingredient. After three to four weeks, DPCD is applied again in a low dosage, which then causes allergic skin irritation. The application is repeated weekly, usually for months.
Experts assume that this allergic skin inflammation on the bald areas of the scalp attracts certain immune cells that “displace” the immune cells that attack the hair root cells. In favorable cases, new hair growth begins after about three months, with pigmentless (white) hair sprouting at first. A few weeks later, pigments are usually deposited in these hairs, but sometimes the new hairs remain white.
Topical immunotherapy is quite complex and carries risks (such as excessive eczema). It therefore belongs in the hands of specially trained doctors.
PUVA against circular hair loss
The abbreviationPUVA stands for psoralen plus UV-A. This photochemical treatment method is used for various skin conditions such as psoriasis and neurodermatitis, and in some cases also for circular hair loss.
The doctor applies a phototoxic psoralen (such as methoxalene) to the affected areas of skin. After a quarter of an hour, he irradiates the area with UV-A light. In many cases, this inhibits the damage to the hair follicles caused by immune cells.
Local PUVA is just as successful for circular hair loss as topical immunotherapy. However, the risk of relapse is even higher here.
Zinc and vitamin D for circular hair loss
Zinc supplements are often recommended for circular hair loss (or other hair loss). Among other things, the trace element is important for a strong immune system and for healthy skin and hair. However, taking zinc probably only helps with circular hair loss if there is actually a zinc deficiency.
Taking vitamin D may also have a positive effect on circular hair loss. However, this has not yet been scientifically proven.
A surprisingly successful “therapy method” is participation in a self-help group: patients with circular hair loss benefit from working through the disease together with other sufferers. For children in particular, participation in a self-help group can sometimes be more successful than any drug treatment.
Alternative treatments for circular hair loss
Sometimes patients with circular hair loss use homeopathy, Schuessler salts and other alternative healing methods.
For example, homeopaths recommend taking Arsenicum album, Lycopodium clavatum, Phosphorus or Vinca minor for alopecia areata. The most suitable Schuessler salt is No. 5 Potassium phosphoricum. However, other remedies such as No. 11 Silicea or No. 21 Zincum chloratum are also said to have a beneficial effect on circular hair loss.
The concepts of homeopathy and Schuessler salts and their specific effectiveness are controversial and have not been clearly proven by studies. Alternative medical methods also have their limitations. You should therefore talk to your doctor in advance.
