It can be alarming to look in the mirror and notice a patch of grey hair in an otherwise youthful head of locks. Known medically as canities circumscripta, greying in a single spot is more common than you might think. While it’s normal for hair to turn grey as we age, a concentrated patch of silver strands can make you feel older than your years. Let’s explore some of the common causes of localized greying and what you can do about it.
What causes greying hair in one spot?
There are a few possible explanations for why you may be going grey in a concentrated area:
- Alopecia areata – This autoimmune condition causes hair loss in patches. As the hair regrows, it may return white or grey rather than the original color.
- Vitiligo – With this skin pigment disorder, melanin (which gives hair its color) is destroyed in certain areas. This can lead to white patches in the hair.
- Injury or trauma – Any type of wound, burn, or other damage to the scalp can temporarily halt melanin production. New hair growth may be white until melanin production returns to normal.
- Fungal infection – Ringworm and other fungal infections can invade the hair follicle leading to brittle, discolored strands.
- Stress – Prolonged or sudden stress may deplete melanin production. This is sometimes seen as a widening streak of gray called the “Marie Antoinette syndrome.”
- Poor nutrition – Deficiencies in vitamin B12, calcium, iron, copper, and zinc can interfere with melanin synthesis.
- Genetics – Sometimes greying runs in families and appears prematurely or in unusual patterns.
While many factors can cause greying hair, localized greying often boils down to one of two culprits: alopecia areata or vitiligo. Let’s take a closer look at these two conditions.
Alopecia areata
Alopecia areata is an autoimmune disease that causes hair to fall out in small, round patches. These bald spots usually occur on the scalp but can appear anywhere on the body. With alopecia areata, the immune system mistakenly attacks the hair follicles, halting hair production.
When the hair regrows, it may be white since the affected follicles temporarily stop making melanin. Alopecia areata can happen at any age but often first appears in childhood or young adulthood. It affects both women and men equally across all ethnic groups.
Doctors don’t know exactly why some people develop alopecia areata. It likely involves genetics and environmental triggers. There is no cure, but some treatments can help hair regrow more quickly. In most cases, the hair will return to its original color once the follicles recover.
Signs and symptoms
- Round bald patches, usually about the size of a coin
- Most common on the scalp but can occur anywhere, including the beard
- Smooth, bald patches with no broken hairs visible
- Regrowth may be white before turning back to original hair color
- In some cases, complete hair loss on the scalp (alopecia totalis) or entire body (alopecia universalis)
Causes and risk factors
- Family history of alopecia areata or other autoimmune disorders like type 1 diabetes, rheumatoid arthritis, thyroid disease, and celiac disease
- Genes that make you more susceptible to developing alopecia areata
- Stressful events such as major life changes or trauma
- Viral infections or other illnesses
- Possibly severe allergic reactions
Diagnosis and treatment
Alopecia areata is diagnosed through a medical history and physical exam. Sometimes a scalp biopsy is done to rule out other causes of hair loss. There is no lab test to definitively diagnose alopecia areata.
Treatments aim to speed up hair regrowth and slow down the progression of hair loss. Options may include:
- Corticosteroid injections – Injections of steroids like triamcinolone directly into bald patches can stimulate regrowth in some people.
- Topical creams and ointments – Corticosteroid creams, anthralin cream, and topical immunotherapy creams applied directly to bald spots may promote hair regrowth and pigmentation.
- Oral medications – Pills like corticosteroids, cyclosporine, and biologics can calm the immune response. However, side effects may limit long-term use.
- Light therapy – Phototherapy with narrowband UVB rays has been shown to stimulate hair growth in some cases.
- Alternative therapies – Options like acupuncture, aromatherapy, and massage have less evidence but may provide relief for some people.
With treatment, up to 80% of people with alopecia areata will regrow some or complete scalp hair within a year. Patience is key, as hair can take several months to regrow once treatment begins. Unfortunately, the condition may recur at any time.
Vitiligo
Vitiligo is a long-term condition in which pale white patches develop on the skin. It’s caused by the lack of melanin, the pigment that gives skin its color. Vitiligo happens when the melanocytes (melanin producing cells) in certain areas are destroyed, leaving behind milky white patches.
When vitiligo affects the scalp, hair follicles in those spots will produce colorless strands. This can cause polka dot patches of white hair to appear. Vitiligo affects about 1% of people worldwide. It can develop at any age but often appears before age 20.
Experts aren’t sure exactly what causes vitiligo but it likely involves a combination of autoimmunity, genetics, and environmental factors. There is no cure, although some treatments can restore skin and hair color in some cases.
Signs and symptoms
- Pale white patches on the skin that are flush with surrounding skin
- Premature graying or whitening of the hair, eyelashes, eyebrows or beard
- Loss of color inside the mouth or nose
- White spots and patches that are symmetrical on both sides of the body
- Gradual enlargement of white patches over time
Causes and risk factors
- Family history of vitiligo
- Autoimmune diseases like thyroid disorder, rheumatoid arthritis, psoriasis, and pernicious anemia
- Genes linked to vitiligo, which can run in families
- Stressful events such as emotional distress, sunburn, or exposure to industrial chemicals
- Neural causes like nerve damage from injury or disease
Diagnosis and treatment
Vitiligo is primarily diagnosed by visual assessment, although sometimes skin biopsies are done. Blood tests, an autoantibody panel, and genetic testing can help rule out underlying autoimmune conditions.
Treatment focuses on restoring skin and hair pigment and stopping the spread of white patches. Options include:
- Topical creams – Creams with calcineurin inhibitors or corticosteroids may help repigment skin and hair.
- Light therapy – Narrow band UVB phototherapy exposes skin to light under medical supervision to stimulate melanin.
- Surgical procedures – Methods like skin grafting, blister grafting, and micropigmentation (tattooing) can camouflage white patches.
- Depigmentation – In severe cases, remaining skin pigment is bleached to create uniform coloring.
Results vary widely but many people see significant repigmentation after several months of treatment. It’s also important to protect vitiligo-prone skin from sun damage with sunscreen, clothing, and avoiding tanning.
When to see a doctor
Make an appointment with your doctor or dermatologist if you notice a new patch of white hair. Be prepared to describe exactly where it is located, how long it’s been there, and whether you’ve had any other recent changes in your hair or skin.
See your doctor right away if the area:
- Appears suddenly
- Seems to be spreading quickly
- Causes itching, burning, pain, or other discomfort
- Occurs along with hair loss or bald patches
Prompt diagnosis and treatment offers the best chance of restoring your natural hair color and preventing progression of spot baldness due to conditions like alopecia areata. Be patient, as it can take several months to see improvement.
When to consider seeing a dermatologist
In addition to your primary care doctor, visiting a dermatologist is advisable if you are experiencing localized greying for unknown reasons. A skin specialist can help identify or rule out underlying causes.
See a dermatologist right away if you have:
- Sudden onset of bald or white patches
- Significant hair shedding along with patchy greying
- New areas of depigmentation on your skin
- White patches appearing in unusual locations like the face, forearms, or hands
- No family history or obvious reason for premature graying
Dermatologists have specialized training and expertise diagnosing and treating hair and skin disorders. They have access to tools like full-body photography, dermoscopy, skin biopsies, blood testing, and UV lamps to evaluate vitiligo, alopecia areata, ringworm, and other pigmentation problems.
Medical treatments for localized graying
Treatment will depend on the underlying cause of your localized hair graying. Here are some of the most common medical treatments:
- Steroid injections – Injecting corticosteroids directly into balding patches can reduce inflammation and stimulate regrowth in alopecia areata. Results are temporary so ongoing injections are needed.
- Immunosuppressants – Medications like methotrexate, cyclosporine, mycophenolate mofetil may be prescribed to inhibit the autoimmune response in alopecia areata or other autoimmune conditions.
- Anti-fungal medications – Drugs like griseofulvin, terbinafine, fluconazole are used to clear fungal infections that can cause temporary graying.
- Topical ointments – Calcineurin inhibitor creams like tacrolimus and pimecrolimus can elicit repigmentation in cases of vitiligo or inflammatory hair loss.
- Light therapy – Targeted UVB phototherapy applied 2-3 times per week may stimulate melanocyte activity and reduce depigmentation.
- Mineral supplements – Correcting deficiencies in iron, zinc copper, vitamin B12 and other nutrients may support melanin production.
Talk to your doctor about potential risks, side effects, and realistic expectations before starting any medical treatments. Be patient, as it can take weeks or months to see improvement in hair color.
Lifestyle remedies and home care
In addition to medical treatments, there are some natural remedies and lifestyle measures you can take to reduce graying and support healthier hair:
- Vitamins and supplements – Antioxidant vitamins like C and E, vitamin B complex, biotin, zinc, copper, and iron supplements support melanin production.
- Stress reduction – Relaxation techniques like meditation, yoga, massage, and counseling can minimize stress-induced graying.
- Scalp massage – Massaging eucalyptus, rosemary, lemon, or other essential oils into the scalp may stimulate circulation and reduce inflammation.
- Healthy diet – Eat a balanced diet rich in vitamins B12, D, iron, copper, and zinc to nurture hair pigment-producing cells.
- Quit smoking – Smoking increases oxidative stress which can accelerate graying. Quitting improves hair health.
- Sun protection – Use sunscreen, hats, and protective styles to prevent UV-induced damage to hair and skin pigment cells.
While natural approaches alone may not reverse graying, they can optimize hair health and support medical treatment. Identifying and addressing nutritional deficiencies, in particular, helps create the internal conditions for your hair to return to its natural color.
When to consider a hair color
If you feel self-conscious about visible gray spots, consider using a concealing hair color while you undergo treatment. This provides an aesthetic fix until the underlying problem can be addressed. However, only use hair dye on areas already affected by graying.
Some tips for minimizing problems with hair coloring include:
- Do a strand test first to identify any allergies or reactions.
- Select a color close to your natural shade to blend in seamlessly.
- Use a semi-permanent or washable color that fades gradually.
- Follow instructions carefully and don’t leave color on too long.
- See a professional stylist for best results with fewer risks.
Check with your doctor to choose a safe hair dye or avoid coloring altogether if you have extensive bald patches or active scalp inflammation. Never use hair color to hide worrisome symptoms from your doctor.
Coping with premature graying
No matter the cause, prematurely graying hair can be troubling. Here are some tips for coping with this change:
- Ask friends and family if they really notice the gray spot – you may be more worried about it than others.
- Focus conversation on your natural hair texture, style, volume and other attributes besides color.
- Change your hair part or style to conceal the spot if needed.
- View celebrities with premature graying as beauty icons.
- Know that you look just as vibrant, youthful and professional with salt-and-pepper strands.
While waiting for color to be restored, embrace your unique combination of pigmented and graying hair. Remind yourself that beauty comes in all hair colors.
Preventing future gray spots
Once you’ve addressed localized graying, you can take steps to prevent new spots from developing:
- Treat any Vitiligo or alopecia areata promptly and consistently
- Take vitamins and antioxidants that support melanin production
- Minimize hair damage from chemicals, heat styling, and tight hairstyles
- Manage stress through regular exercise, meditation, counseling, or other strategies
- Quit smoking and avoid second-hand smoke which can de-pigment hair.
- Eat a balanced, micronutrient-rich diet.
- Use sun protection including hats, sunscreen and protective styles.
While you can’t always prevent graying as you age, protecting your hair health and pigment cells can keep premature graying spots at bay.
Conclusion
Discovering a patch of graying hair can be alarming but is rarely cause for serious concern. Localized graying is usually due to common conditions like alopecia areata or vitiligo. With an accurate diagnosis from your doctor or dermatologist, most cases can be successfully treated and reversed.
Use a combination of medical treatments, natural remedies, careful hair care and concealers while underlying pigmentation restores. Stay patient through this process, as it can take months for your hair color to recover. Proper management can keep you looking vibrant and youthful despite premature graying.
