What do alopecia patches look like?

Alopecia areata is an autoimmune condition in which the body’s immune system targets hair follicles, leading to sudden, well-defined patches of hair loss. Understanding what alopecia patches look like can help you spot changes early and seek appropriate care. Below is an overview of the typical features of alopecia patches—both to the naked eye and under magnification—based on expert guidelines (Olsen et al. 2004; Miteva & Tosti 2016) and other reputable sources.

What Alopecia Patches Look Like to the Naked Eye
Alopecia patches most often appear on the scalp but can affect any hair-bearing area (beard, eyebrows, eyelashes, body hair). Key characteristics include:

• Well-defined, round or oval bald areas
• Smooth, normal-colored skin (no redness or scaling)
• Sizes ranging from a few millimeters to several centimeters in diameter
• One or multiple patches that may develop suddenly (over days to weeks)
• No scarring or permanent skin changes in most cases

Patients often describe feeling a sudden “hole” in their hair, as if a clump of hair has been removed. Touching the patch feels like smooth skin, with no raised or bumpy texture.

Common Visual Features
When you look closely at an alopecia patch, you may notice:

• “Exclamation mark” hairs – short hairs that are narrower at the base and thicker toward the tip, often seen at the edges of the patch
• Black dots – broken hair shafts at scalp level, giving a dotted appearance
• Yellow dots – follicular openings filled with keratin and sebum, creating small yellowish circles
• Short, fine “vellus” hairs – indicating early regrowth in some areas

These features are more apparent under magnification (trichoscopy) but can sometimes be seen with a strong hand-held magnifier or high-resolution camera.

Trichoscopic (Dermoscopic) Findings
Trichoscopy is a noninvasive way to examine the scalp and hair follicles under polarized light. According to Miteva & Tosti (2016), key trichoscopic clues in alopecia areata include:

• Yellow Dots
– Uniform, round or polycyclic yellow-brown dots corresponding to distended follicular infundibula
– Most prominent in chronic or long-standing patches

• Black Dots
– Composed of pigmented broken hair shafts seen at the scalp surface
– Marker of active disease

• Exclamation Mark Hairs
– Hair shafts thinner at the scalp exit point, thicker distally
– Reflect proximal hair shaft inflammation and weakening

• Short Vellus Regrowth
– Thin, lightly pigmented hairs indicating follicles are still viable and potentially regrowing

• Cadaverized Hairs (Circle Hairs)
– Round, coiled plucked hairs found in some cases

Trichoscopy can help distinguish alopecia areata from other non-scarring hair loss conditions (like telogen effluvium or androgenetic alopecia) by highlighting these hallmark features.

Progression and Pattern Variations
Alopecia areata can present in several patterns:

1. Single Patch
   – One isolated bald area, most common presentation
2. Multiple Patches
   – Several discrete areas of hair loss that may merge over time
3. Alopecia Totalis
   – Complete loss of scalp hair
4. Alopecia Universalis
   – Total loss of all body hair

In many cases, new patches appear intermittently. Some patches may regrow hair spontaneously, while others persist or enlarge. Regrowth often begins with white or non-pigmented hairs before returning to normal color.

How to Differentiate from Other Causes
Because other conditions can cause patchy hair loss, it’s useful to note the absence of:

• Scale or flaking (suggestive of fungal infection)
• Scarring, atrophy, or skin discoloration (seen in discoid lupus or lichen planopilaris)
• Inflammation, pustules, or pain (common in folliculitis or bacterial infections)

If you’re unsure, a dermatologist can perform a simple scalp biopsy or fungal culture to rule out mimicking disorders.

When to Seek Professional Advice
If you notice one or more smooth patches of hair loss, consider taking a moment for a free, online symptom check for Alopecia Areata. It only takes a few minutes and can help you understand whether your signs match common alopecia areata patterns. Click here to start your free symptom check for Alopecia Areata.

Early evaluation can lead to faster treatment decisions and better outcomes. While alopecia areata itself isn’t life-threatening, rapid or extensive hair loss may signal other autoimmune issues (thyroid disease, vitiligo) that warrant medical attention. Always:

• Speak to a doctor if you experience sudden, extensive, or painful hair loss
• Mention any changes in nails (pitting, ridging) or other autoimmune symptoms
• Ask about blood tests (thyroid function, autoimmune markers) if recommended

Treatment Options
Though there’s no definitive “cure” for alopecia areata, several therapies can stimulate regrowth:

• Topical corticosteroids (creams or foams)
• Intralesional steroid injections for localized patches
• Topical immunotherapy (e.g., diphencyprone)
• Minoxidil (topical) to support regrowth
• Systemic corticosteroids for widespread disease
• JAK inhibitors (newer oral agents) under specialist supervision

Your dermatologist will tailor treatment based on patch size, location, number, and how fast new patches appear.

Coping and Monitoring
Living with visible hair loss can be emotionally challenging. In addition to medical treatments, consider:

• Cosmetic camouflage: powders, sprays, or wigs
• Support groups: connecting with others facing alopecia areata
• Stress-reduction techniques: mindfulness, exercise, therapy

Regular follow-up appointments help monitor new patches, assess response to therapy, and screen for related autoimmune conditions.

Key Takeaways: Alopecia Patches Features
• Well-defined, smooth, round or oval bald spots
• Normal skin color and texture within patches
• Exclamation mark hairs, black dots, yellow dots under magnification
• Possible progression to totalis or universalis in severe cases
• Distinct from scarring hair loss by lack of skin damage

If you spot these features, you might consider doing a free, online symptom check for Alopecia Areata. Early recognition and discussion with a healthcare provider can make a real difference. Always speak to a doctor about any sudden or worrying hair loss, especially if you experience extensive patches, scalp discomfort, or other systemic symptoms.