Alopecia areata is an autoimmune disorder that produces round patches of hair loss on the scalp and other body areas. It is noncontagious and variable in course - some people regrow hair spontaneously, others have recurrent or extensive loss. Dermatologists diagnose AA clinically and offer treatments ranging from intralesional corticosteroids and topical therapies to topical immunotherapy and oral JAK inhibitors (baricitinib approved for severe cases). Cosmetic camouflage and psychological support are key parts of management.
What is alopecia areata?
Alopecia areata (AA) is an autoimmune condition that causes patchy hair loss. The immune system mistakenly targets hair follicles, which stops hair growth in small, round areas. It can affect any hair-bearing site: the scalp, beard, eyebrows, eyelashes and body.
AA is not contagious. It can start at any age and affects people of all genders. The course is unpredictable: some people experience a single episode and full regrowth, while others have repeated cycles of loss and regrowth or progress to more extensive forms such as alopecia totalis (complete scalp loss) or alopecia universalis (loss of all body hair).
Common signs and related conditions
Typical early signs are one or more smooth, coin-sized bald patches. Some people notice itching, tingling or a burning sensation before hair falls out. AA is associated with other autoimmune conditions in some patients, most commonly thyroid disease and vitiligo. If you have other autoimmune symptoms, discuss them with your clinician.
Diagnosis and prognosis
A dermatologist usually diagnoses AA by clinical exam. In uncertain cases they may use a scalp biopsy or blood tests to rule out other causes. Prognosis varies: many people regrow hair spontaneously within months to a year, but regrowth is not guaranteed and relapses are common.
Treatment options (overview)
There is no single cure, but several treatments can stimulate regrowth or modify the immune response. Choice depends on age, extent of hair loss and patient preference.
- Intralesional corticosteroid injections: A common first-line treatment for limited scalp patches in adults. Injections are usually given every 4-6 weeks.
- Topical corticosteroids and topical minoxidil: These may help, particularly as adjuncts, and are often used in children or for milder disease.
- Topical immunotherapy (e.g., diphencyprone/DPCP) and anthralin: Options for extensive or treatment-resistant cases to provoke a local immune response that can encourage regrowth.
- Oral JAK inhibitors: Janus kinase (JAK) inhibitors have emerged as an effective option for severe or extensive AA. Baricitinib (an oral JAK inhibitor) received FDA approval for adults with severe AA and has shown meaningful hair regrowth in trials. These medications carry potential risks and require specialist supervision and monitoring.
- Systemic corticosteroids and other immunosuppressants: Reserved for select cases because of side effects.
Living with AA
Cosmetic options - wigs, hairpieces, scarves, eyebrow microblading and cosmetic camouflage - are valid choices at any stage. Psychological impact can be significant; counseling or support groups can help with coping and self-image.
When to see a dermatologist
Seek specialist care if you notice sudden patchy hair loss, rapid spreading, involvement of eyebrows/eyelashes, or if hair loss affects your wellbeing. A dermatologist can confirm the diagnosis, discuss medical and cosmetic options, and outline monitoring for treatments like JAK inhibitors.