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Alopecia areata is an autoimmune disorder in which the immune system mistakenly attacks hair follicles, resulting in sudden, patchy hair loss on the scalp, face, and sometimes other areas of the body. It can begin at any age and often appears suddenly, with no prior symptoms.
Small, round, smooth patches of hair loss, primarily on the scalp
Tingling or burning in the affected area (less common)
Nail abnormalities: pitting, ridging, or brittleness
Regrowth of white or fine hair in affected areas
In more severe forms, complete loss of scalp hair (Alopecia Totalis) or all body hair (Alopecia Universalis)
Alopecia areata happens when the body’s immune system mistakenly attacks the hair follicles, causing hair to fall out. It’s not something you did or something you caught—it’s your own body confusing your hair as something harmful.
Here are the main things that seem to contribute:
Normally, your immune system protects you from germs. But in alopecia areata, it gets confused and attacks the hair roots, especially when the hair is actively growing.
This causes the hair to fall out, often in small, smooth patches.
Alopecia areata can run in families. If a parent or close relative has it or another autoimmune condition, you may be more likely to get it too.
That doesn’t mean you will get it, just that your chances are a little higher.
Sometimes something may “set off” the immune system, especially in people who are already at risk. These triggers might include:
A virus or illness
Stress—either emotional or physical
Hormonal changes
Certain medications (rarely)
Even injury or trauma to the skin in some cases
People with alopecia areata sometimes also have other autoimmune conditions like:
Thyroid disease
Vitiligo (white patches on the skin)
Type 1 diabetes
Lupus
Rheumatoid arthritis
That’s because the immune system problems behind alopecia areata are similar to those in other autoimmune diseases.
Clinical evaluation of the hair loss pattern and affected areas
Pull test to see how easily hair comes out
Dermatoscopy to examine the scalp
Scalp biopsy (if uncertain)
Blood tests to rule out other autoimmune conditions or thyroid dysfunction
There is no cure, but several treatments may promote hair regrowth or reduce the immune response:
Topical corticosteroids or intralesional steroid injections
Topical immunotherapy (e.g., diphenylcyclopropenone or squaric acid dibutylester)
Minoxidil (Rogaine) to stimulate hair growth
JAK inhibitors (e.g., baricitinib) – FDA approved for severe cases in adults
Oral corticosteroids (short-term use)
Supportive treatments: wigs, cosmetic camouflage, and counseling
Many cases resolve spontaneously within 12 months, especially milder cases
However, recurrence is common, and regrowth may be temporary
Severe cases (e.g., total scalp or body hair loss) are less likely to fully recover
Emotional and psychological support is important due to the impact on self-image
Affects approximately 1 in 500 to 1 in 1,000 people worldwide
Lifetime risk estimated at 2%
Affects males and females equally
Can begin in childhood or adulthood; most common onset is before age 30
National Alopecia Areata Foundation. https://www.naaf.org
Gilhar, A., Etzioni, A., & Paus, R. (2012). Alopecia areata. New England Journal of Medicine, 366(16), 1515-1525.
Messenger, A. G., & McKillop, J. (2018). Alopecia areata: An autoimmune disease. British Journal of Dermatology, 179(5), 1003–1011.
FDA. (2022). Approval of baricitinib for Alopecia Areata. https://www.fda.gov
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