Alopecia areata typically appears as one or more smooth, round or oval bald patches, roughly the size of a coin. The exposed skin in these patches looks normal, with no redness, flaking, or scarring. This clean, smooth appearance is one of the most distinctive features of the condition and often what separates it from other causes of hair loss.
The Classic Patch Pattern
The most common form, called patchy alopecia areata, starts with sudden hair loss in well-defined circular or oval areas. These patches can appear on the scalp, beard, eyebrows, eyelashes, or anywhere else on the body. The borders are usually sharp and easy to spot. The skin underneath feels smooth to the touch and looks essentially healthy.
What makes these patches especially recognizable is what happens at the edges. You’ll often notice short, broken-off hairs that are thinner at the base and wider at the tip, sometimes called “exclamation point” hairs. They’re typically about 1 centimeter long and signal that hair loss is actively happening in that area. These tapered hairs are one of the hallmarks that distinguishes alopecia areata from other types of hair loss.
Inside the patch itself, you may also see tiny black dots where hairs have broken off at the scalp surface, along with fine, wispy hairs that are thinner and lighter than your normal hair.
How It Looks on Different Skin Tones
On lighter skin, the bald patches tend to appear as pale, featureless areas that contrast with the surrounding hair. On darker skin, the patches may show a honeycomb-like pigmented pattern across both the affected and unaffected scalp. This network of pigment is a normal feature of darker skin and doesn’t indicate scarring or a different condition. The key markers, like exclamation point hairs and black dots, are still present on darker skin, though they can sometimes be harder to spot without magnification.
Beyond the Scalp
When alopecia areata affects the beard, it creates the same smooth, coin-sized bald spots along the jawline, chin, or cheeks. This form is sometimes called alopecia barbae. Close inspection reveals the same signs: tiny black dots, short tapered hairs, and fine regrowth hairs scattered within the patch. Beard patches can be particularly noticeable because facial hair is coarse and the contrast between bare skin and surrounding stubble is stark.
Eyebrow and eyelash hair loss tends to look different simply because there’s less hair to lose. You might notice a thinning section or a gap in one eyebrow, or a stretch of missing eyelashes along one lid. These changes can be subtle at first.
More Extensive Patterns
Not everyone with alopecia areata has isolated coin-sized patches. The condition has several broader patterns that look quite different from one another.
- Ophiasis pattern: Hair loss forms a band or strip around the sides and back of the scalp, following the hairline. This pattern can be harder to treat and is sometimes hidden by longer hair on top.
- Alopecia totalis: Complete loss of all hair on the scalp. The entire head appears smooth and bare.
- Alopecia universalis: Loss of all hair on the scalp and body, including eyebrows, eyelashes, arm hair, and leg hair. This is the rarest form.
Doctors sometimes use a scoring system that grades severity by the percentage of scalp hair lost, from under 25% (mild) to 100% (complete). Most people with alopecia areata stay in the milder range with just a few patches.
Nail Changes You Might Not Expect
About 22% of people with alopecia areata also develop visible changes to their fingernails or toenails. The most common is pitting: tiny, shallow dents scattered across the nail surface in a grid-like pattern. These pits are often so superficial they look more like gentle waves or ripples rather than obvious holes.
Some people develop what’s called trachyonychia, where the nail surface becomes rough and matte, as if it had been lightly sandpapered. Other changes include white spots on the nails, reddening of the half-moon at the nail base, and vertical ridges running from cuticle to tip. These nail signs are more common in people with extensive hair loss, but they occasionally appear on their own, even before any hair falls out.
How to Tell It Apart From Other Hair Loss
The smoothness of the bare skin is the biggest visual clue. Fungal scalp infections (tinea capitis) can also cause round bald patches, but they’re usually accompanied by scaling, redness, itching, and sometimes small pustules. Alopecia areata patches have none of that. The skin looks and feels completely normal aside from the missing hair.
Traction alopecia, caused by tight hairstyles pulling on hair over time, tends to follow the hairline or part line rather than forming random round patches. And typical pattern baldness (androgenetic alopecia) progresses gradually in predictable areas like the temples, crown, or along the part, rather than appearing suddenly as distinct round spots.
What Regrowth Looks Like
When hair begins to grow back in an alopecia areata patch, it often looks different from the hair you lost. The first regrowth is frequently white or much lighter than your natural color, with a finer, sometimes slightly different texture. This happens because the hair follicle starts producing a hair shaft before it resumes normal pigment production. Over time, the color and thickness typically return to normal, though this process can take months. Seeing fine white fuzz in a previously bare patch is generally a positive sign that the follicles are recovering.
Regrowth isn’t always permanent. Some patches fill in completely while new patches appear elsewhere. It’s common to see different stages at the same time: one patch growing back with fine white hair, another patch that’s been stable for weeks, and a fresh patch with exclamation point hairs at its edges showing active loss.