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Bald patches 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 ‘moth-eaten’ 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. In about 1 in 20 people with alopecia areata, the hair loss continues, so there will be total hair loss.
Hot-combing with pomades. Some women apply a pomade to the hair and then use a hot-comb to straighten or style the hair. This can cause problems. The hot-comb melts the pomade, which drips down the hair to the root and into the hair follicle, where it can cause inflammation. The inflammation can damage the hair follicles and cause a bald patch, which can be permanent in severe cases. Hot-combing or using pomades alone is all right – it is using them together that causes the trouble. 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 is probably caused by a 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, so it is worth discussing the problem with your doctor.
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