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Alopecia Areata

Also Known As: Autoimmune alopecia, spot baldness, Patchy Hair Loss, Alopecia Celsi
System: Integumentary System
Autoantibodies: No specific autoantibody is diagnostic for alopecia areata, but patients may have: Antinuclear antibodies (ANA) (in some cases) Thyroid antibodies (e.g., anti-TPO), especially if comorbid autoimmune thyroid disease is present
Primary Organ or Body Part Affected: Hair follicles (especially on the scalp, but can also affect eyebrows, eyelashes, beard, and body hair)
Acceptance as Autoimmune: Confirmed
Alopecia Areata

What is Alopecia Areata?

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.

What are the signs and symptoms of Alopecia Areata?

  • 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)

What are the causes of Alopecia Areata?

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:

1. Autoimmune Reaction

  • 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.

2. Genes (Family History)

  • 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.

3. Triggers from the Environment

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

4. Other Autoimmune Conditions

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.

Diagnosis

  • 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

Treatment

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

Prognosis

  • 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

Prevalence

  • 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

Citations

  • 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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