Alopecia areata comes in many forms. It can occur in bands, round or oval patches, or with whole head and body balding. What are even more unusual are the features that are usually only known to doctors who are interested in hair (like a hair surgeon or a dermatologist). For instance, it is well-known that;
Spare the White Hair: Different forms of areata seem to spare white hairs and yet attack pigmented hairs. Also, when hair grows back after falling out due to areata, it can sometimes grow back white, even if it had color before. Unfortunately, having white hair does not protect you from getting areata, however.
Mosaic: Patients may be familiar with a mosaic of tile on a floor or on a wall, but the patches of hair that form in alopecia areata can form a mosaic too. When many different circles of hair loss occur at once, or if they even decide to merge, the pattern is known as mosaic.
Exclamation Point Hairs: If a patient looks closely at the edges of an area of active alopecia areata, short 1-2 mm hairs can often be seen. These hairs are particularly unusual, though, because unlike normal hair that starts out fat at the bottom and thins out toward the top like a pine tree, they are skinny at the skin and fat at the end. In other words, they look like a tree turned upside-down, or an exclamation point (without the little dot). Doctors call these “exclamation point hairs” and they usually indicate that active alopecia areata is the likely cause of the balding.
Fuzz: When a patch of areata starts to re-grow, it sometimes gets stuck between two of the growing phases of hair (anagen, catagen, and telogen). More specifically, the hair does not fully enter the “Growth” phase (known as anagen) from the “Resting” phase (known as telogen) which usually comes right before it. Thin wispy re-growth results, kind of like a half-hearted, fuzzy attempt to grow a hair. On top of that, the body sometimes decides that new, fine hair should now be white, or even curly. Go figure.
Nails: Alopecia areata can affect the nails as well as the hair. Long and noticeable ridges, pits in the nails themselves, and brittle nails are all changes that can be seen, either before, during, or after an episode of alopecia areata. Even though it is less of a cosmetic concern, these nail changes can be frustrating and pervasive.
Many other strange associations with alopecia areata exist besides these, which is why areata is such a difficult disease to diagnose and manage. Thyroid conditions, atopic dermatitis, and even possibly a decrease in the number of sweat glands (a possibility some people would feel positively about) have all been noted in this chameleon condition. If you have alopecia areata, or if you think you might have it, knowing some of these more unusual manifestations can give you a sense of control over and help you keep up with this tricky disease.