Alopecia Areata
Alopecia areata is an autoimmune condition that makes hair fall out in smooth, round patches. The immune system switches the follicle off rather than destroying it, so hair can come back - but it is unpredictable, and no one can tell in advance who will regrow and who will not.
Key facts
Alopecia Areata at a glance.
Typical signs
Smooth, patchy hair loss
Common locations
Scalp, beard, brows
Expected course
Unpredictable regrowth and recurrence
Treatment options
Steroids or selected immune treatments
What is it?
Top things to know about Alopecia Areata
- It is immune-driven hair loss. The immune response disrupts active hair follicles.
- It does not usually scar. It differs from infection, pattern thinning and scarring alopecia.
- It can start suddenly. A smooth patch can appear quickly.
- Regrowth may look different. Early regrowth is often fine or pale at first.
What it looks like
What Alopecia Areata looks like
Alopecia areata is an autoimmune condition that causes hair to fall out in round or oval patches. The bald patches are smooth, with no scarring, redness or scale. Short broken hairs that narrow toward the scalp, called exclamation-mark hairs, often appear at the edges. It most often affects the scalp, but can also affect the beard, eyebrows, eyelashes and body hair. Nails may develop tiny pits.
Alopecia areata is grouped by how much hair is lost.
Patchy alopecia areata
One or more round patches; most common.
Beard involvement
A smooth hairless patch interrupts the beard.
Ophiasis pattern
A band along the sides and back.
Alopecia totalis
Loss of all scalp hair.
Alopecia universalis
Loss of all body hair.
Where it shows up
The marked patch is one possible scalp location. Patches can occur elsewhere, including beard, eyebrow or body hair.
Scalp and behind the ears
Locations on the back of the head.
On different skin tones
Alopecia Areata on different skin tones
Alopecia areata affects all skin tones and hair types. On lighter skin, bald patches may look pale or slightly pink. On brown and Black skin, patches may be lighter or darker than the surrounding scalp, and they can be confused with traction alopecia or scalp ringworm, both of which are more common in coiled hair.
What happens in Alopecia Areata?
Immune activity around growing hair follicles disrupts hair production and can cause affected hairs to shed. The follicles usually remain present, so regrowth is possible, although the course varies.
- Hair growth is disrupted: Affected hairs can become weak or shed.
- The follicle usually remains: Regrowth is possible, but the course varies.
- Immune cells target the follicle: The response gathers around growing hair roots.
Causes and triggers
What causes Alopecia Areata
Causes
Why it happens
Alopecia areata is an autoimmune condition. The immune system attacks hair follicles, causing round patches of hair loss.
About 1 in 5 people with it have a relative with it.
Risk factors
Raise the odds
- Family history
- Eczema or asthma
- Thyroid disease
- Other autoimmune conditions
Triggers
Bring it on or make it worse
- Severe stress (Possible)
- Illness (Possible)
When it usually starts
When it usually starts
Alopecia Areata
Can start at any age, often in childhood or younger adult life.
Daily care
Daily care for Alopecia Areata
Sun protection on bare scalp
Sunscreen, a hat or a scarf.
Wigs, toppers, brows and lashes
Use cosmetic options if they help you feel comfortable with visible hair loss.
Talking to someone about it
Anxiety and low mood are well documented, and support groups exist.
Oral JAK inhibitors
Can regrow hair in very extensive loss, with monitoring and real risks.
Follow treatment for a confirmed thyroid problem
Treating it does not regrow hair, but it is worth finding.
Avoid: Assuming a patch will sort itself out
Waiting costs most when loss is spreading.
Avoid: Chasing unproven cures
Months lost while a spreading case goes untreated.
Avoid: Severe or prolonged stress
Often reported before flares, hard to prove.
Avoid: Sunburn on bare scalp
Skin never exposed burns fast and marks for months.
Avoid: Stopping treatment at first regrowth
Regrowth means the attack is suppressed, not over.
Treatments
Treatments for Alopecia Areata
Topical Minoxidil
Minoxidil does not switch off the immune attack, so it will not clear a patch on its own here. What it does is support hair that is already coming back, which is why it is usually added to injections or a steroid rather than used by itself. It has to be kept up to keep any benefit.
Biotin and hair supplements
Biotin, collagen and hair-and-nail supplements are the first thing most people try. They do nothing for alopecia areata, because the problem is an immune attack rather than a shortage of a nutrient. Iron, vitamin D or thyroid problems are worth checking and correcting if a blood test shows one, but supplements taken on spec are not a treatment.
Rosemary oil and onion juice
These circulate constantly online, and neither has evidence worth acting on in alopecia areata. Because many single patches fill in on their own within a year, whatever someone was using at the time gets the credit. They are mostly harmless in themselves — the real cost is the months that pass while a spreading case goes untreated.
Wigs, toppers, brows and lashes
Not a lesser option, and not giving up. Wigs, toppers, scalp micropigmentation, brow pencils and false lashes let people carry on while treatment is tried, and many people use them for years alongside everything else. In the US many insurers cover a wig with a prescription, so it is worth asking your dermatologist to write one.
Clobetasol
Clobetasol Propionate. A strong topical steroid used on the patch, often under a cover overnight to push it in. It is slower and less reliable than injections, and it is the usual choice for children and for anyone who does not want needles. Used for months on the same area it can thin the skin, so it is worked in cycles with breaks rather than applied indefinitely.
Anthralin
Anthralin cream. An old treatment applied for a short time each day and then washed off, deliberately causing a mild irritation that seems to distract the immune system from the follicle. It is used mainly in children and when steroids have not worked. It stains skin, hair and towels a brown-orange, and it needs patience over months.
Olumiant
A JAK inhibitor tablet, approved for severe alopecia areata in adults, that blocks the immune signals attacking the follicle. In trials a substantial share of people with extensive loss regrew most of their scalp hair over several months to a year. It is not a cure — the loss usually returns after stopping — and it needs blood tests before and during treatment, with real risks around infection, blood clots and cholesterol to weigh up first.
Litfulo
A second JAK inhibitor tablet for severe alopecia areata, approved from age 12, which makes it the option for teenagers as well as adults. The results, the monitoring and the trade-offs are broadly similar to baricitinib, and which one is chosen often comes down to age, other health conditions and what your insurance covers. A third, deuruxolitinib, is also available for adults.
Prednisone
A short course of steroid tablets is sometimes used to slow loss that is spreading quickly. It can work while it is being taken, and hair frequently falls out again once it stops. Because the side effects of long-term steroids are serious, it is a bridge to another treatment rather than a plan on its own.
Methotrexate
An older immune-suppressing tablet used for extensive alopecia areata, sometimes with a low dose of steroid alongside. It has been overtaken by the JAK inhibitors for most people, and it stays useful where those are not available, not affordable or not suitable. It takes months to judge, needs regular blood tests, and must not be taken in pregnancy.
Cortisone Injection
Steroid Injections. The fastest reliable option for a limited number of patches, and the usual first treatment in adults. Several small injections are placed across a patch, repeated every four to six weeks, with regrowth often visible in one to two months. They sting for a few seconds each, and numbing cream beforehand is fine to ask for. They can leave a lighter patch of skin or a small dent where the fat has thinned, which usually recovers over months and shows more on deeper skin tones. They treat the patches injected, not the tendency.
Contact Immunotherapy
A chemical is painted on the scalp to set off a deliberate mild allergic reaction, which appears to pull the immune system's attention away from the follicles. It is one of the better options for widespread loss where injections are not practical, and it is done in specialist centers. It means a mildly itchy, red, flaky scalp every week for months, and results take that long to appear.
Excimer Laser
Targeted ultraviolet light delivered to individual patches, usually twice a week for a few months. It is painless and can be useful for a small number of stubborn patches, including in children who cannot manage injections. The evidence is thin, regrowth often fades after treatment stops, and it asks for a lot of clinic visits.
PRP for Hair Loss
Your own blood is spun down and the platelet-rich part injected into the patch. Small studies in alopecia areata have shown some regrowth, but they are few and short, and there is no agreed recipe or schedule. It is not covered by insurance and courses are expensive, so it is a reasonable thing to try after the better-tested options rather than instead of them.
Hair Transplant
This is the wrong operation for alopecia areata, and it is worth knowing why before anyone offers it. The follicles here are alive and switched off rather than gone, so there is nothing to replace, and moved hairs land in skin where the same immune attack is still running and can be lost too. Transplants are for scarring hair loss and for pattern hair loss, where the follicle really has been destroyed.
Outlook
What to expect with Alopecia Areata
Alopecia areata is unpredictable. The follicle survives throughout, however long the hair has been gone, which is why treatment stays worth trying after a long gap.
- 1
First patch · The usual start
One or a few coin-sized patches, usually on the scalp.
- 2
Several months to a year · Regrowth
Patches often fill in over several months to a year with no treatment. Fine white or pale hairs appear first, then thicken and take on color. White regrowth is normal, not a failed treatment.
- 3
Later episodes · Over years or decades
One episode makes another more likely at some point, and many people cycle through loss and regrowth over decades.
- 4
A harder course · Features that predict it
Loss starting in early childhood, loss over a large part of the scalp, a band running around the lower edges behind the ears, nail involvement, and a long history of episodes all point to a harder course. None is a verdict - people with extensive loss do regrow, sometimes years in.
- 5
Total loss · Alopecia totalis and universalis
Alopecia totalis is all scalp hair, universalis is scalp and body hair. Spontaneous regrowth is less likely than from a single patch, and this is the group for whom the newer oral treatments changed what is on offer.
Complications
Complications to know about
Sunburn on an unprotected scalp
Scalp skin that has been covered by hair all its life has no tan and no toughening, so it burns very fast — sometimes within twenty minutes. A burn there is painful, it can blister, and on deeper skin tones it often leaves a dark mark that outlasts the burn by months. Sunscreen, a hat or a scarf on any bare area prevents it entirely, and it is the easiest thing on this page to avoid.
Losing Eyebrows and Eyelashes
In some people the immune attack takes the brows and lashes as well as the scalp. Lashes keep dust, sweat and grit out of the eye, so losing them can leave the eyes gritty, watery and easily irritated, and wind and bright light feel worse. Sunglasses help day to day. This is also the loss people find hardest to cover, and it is a reasonable thing to bring up at the appointment rather than manage alone.
Anxiety and low mood
The weight of this is not a side issue. People field questions from strangers, cover up in photographs, and wake up not knowing what they will find on the pillow, and anxiety and low mood are well documented in alopecia areata. It is worth saying out loud at the appointment if it is affecting your sleep, your work or your mood. Support groups exist, and many insurers in the US cover a wig with a prescription.
When to get help
When to get help
When to seek care
Arrange assessment for new patchy hair loss, eyebrow or eyelash loss, or rapid progression. Scalp scale or pain may indicate a different cause.
Lookalikes
What else could it be?
Ringworm
Alopecia areata leaves smooth, clear skin inside a bald patch. Scalp ringworm more often causes scale and broken hairs and needs medical treatment.
Telogen Effluvium
Alopecia areata leaves distinct, round bald patches. Telogen effluvium causes shedding across the whole scalp, without completely bare circles.
Male Pattern Hair Loss
Male pattern hair loss usually develops slowly at the temples and crown. Alopecia areata can leave a sharply outlined bald patch within days or weeks.
Questions
Questions you might be asking.
Will my hair grow back?
Often, but nobody can promise it. A single small patch fills in within a year in a large share of people, with or without treatment. Widespread loss is much less predictable. There is always a chance, because the follicle is switched off rather than destroyed, even after years.
Is this caused by stress?
Stress may trigger it in someone already predisposed. It is not the underlying cause, and calming your life down is not a treatment. Manage stress for its own sake, and do not blame yourself for the hair.
Is it contagious? Can my children catch it?
No. It cannot be passed by contact of any kind. There is an inherited tendency, so your children have a somewhat higher chance of developing it, but that is genetics rather than transmission.
Does this mean I will get other autoimmune diseases?
Not necessarily. Thyroid disease, vitiligo and a few others are more common, which is why thyroid function is checked once. Most people never develop another.
Do the steroid injections hurt, and how often do I need them?
They sting for a few seconds each, and there are usually several across a patch, so the appointment is uncomfortable rather than painful. They are typically repeated every four to six weeks while there is reason to continue. Numbing cream helps, and it is fine to ask for it.
Why did my hair come back white?
That is normal here. The pigment cells take longer to restart than the hair-making cells, so new growth comes through fine and pale before it thickens and regains color over the following months. It is a sign of recovery, not failure.
Sources
Sources and further reading
Related
Keep exploring.
Male Pattern Hair Loss
PRP for Hair Loss
Telogen Effluvium
Topical Minoxidil
Hair Transplant
Methotrexate
Cortisone Injection
Prednisone
Ringworm
Clobetasol
Excimer Laser
