How Does Alopecia Areata Progress To Alopecia Totalis?

Sakina Groth

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Hi all. I developed alopecia areata last summer after starting Letrozole, a fertility medication. I had one large spot which was starting to grow back when I developed another. A few months after that, another. I am now pregnant, so I can't get any treatment or medication, but I can feel two new spots developing.

I feel like I'm shedding more hair overall and I'm wondering if my alopecia areata is progressing into alopecia totali or universalis. For those of you that have had this happen, what did the trajectory look like? How quickly did it move from a spot or two to something much more serious? Did grow into many more spots or diffuse shedding allover?


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Alopecia areata (AA) is an autoimmune disease that causes patchy hair loss. In some cases, it can progress to alopecia totalis (AT), which is complete hair loss on the scalp. Here's a breakdown of how this might happen:

Alopecia Areata (AA):

  • AA disrupts the normal hair growth cycle by attacking the hair follicles. This leads to the formation of smooth, round patches of hair loss, typically on the scalp, but it can affect eyebrows, eyelashes, and other body hair as well.
  • The severity of AA can vary. Some people experience only a few small patches, while others may have more extensive hair loss.
Progression to Alopecia Totalis (AT):

  • The exact reasons why AA progresses to AT are not fully understood. However, some theories suggest:
    • Increased Autoimmune Activity: The immune system's attack on hair follicles might become more widespread, leading to more extensive hair loss.
    • Follicle Vulnerability: Hair follicles in some individuals might be more susceptible to immune system attack, making them more prone to complete hair loss.
Risk Factors for Progression:

  • Age of Onset: Studies suggest that children and young adults diagnosed with AA might have a higher risk of progressing to AT compared to adults.
  • Number and Size of Patches: Individuals with several large patches of hair loss at the time of AA diagnosis might be more likely to develop AT.
  • Nail Involvement: If AA also affects the nails, causing pitting or dents, it could be an indicator of a higher risk of progression.
It's important to understand that:

  • Not everyone with AA progresses to AT. Many people experience only patchy hair loss that may regrow over time.
  • The progression from AA to AT can be unpredictable. It can happen quickly in some cases, while in others, it might take years or never occur.
Here's what you can do:

  • Consult a Dermatologist: They can diagnose your specific type of alopecia and discuss your risk factors for progression.
  • Early Intervention: Starting treatment for AA early can potentially help control the condition and might reduce the risk of progression to AT. Medications like corticosteroids or topical minoxidil might be used.
  • Monitor Your Condition: Pay attention to any changes in your hair loss pattern. If you notice more extensive hair loss, consult your doctor to discuss treatment adjustments.