Alopecia areata is one of the most common autoimmune conditions affecting the hair, estimated to affect approximately 2% of the population at some point in their lives. Unlike androgenetic alopecia (pattern baldness), alopecia areata does not follow a predictable progressive pattern — it can appear at any age, on any part of the scalp or body, and may spontaneously remit.
What Is Alopecia Areata?
Alopecia areata occurs when the immune system mistakenly attacks hair follicles, causing them to enter a premature resting phase and stop producing hair. The follicles are not destroyed — they remain alive beneath the scalp surface — which is why regrowth is possible.
The condition typically presents as one or more round or oval patches of complete hair loss, usually on the scalp but sometimes in the beard, eyebrows, eyelashes, or body hair.
Types of Alopecia Areata
Alopecia areata (patchy): One or more patches. The most common form.
Alopecia totalis: Complete loss of scalp hair.
Alopecia universalis: Complete loss of all body hair, including eyebrows, eyelashes, and body hair. The most severe form.
Diffuse alopecia areata: General thinning rather than patchy loss — less common and sometimes confused with other causes.
What Causes It?
Alopecia areata is an autoimmune condition. The exact trigger is not fully understood. Genetic predisposition plays a role — approximately 20% of patients have a family member with the condition. Stress and illness may trigger episodes in genetically susceptible individuals, though this relationship is not definitively established.
Diagnosis
Diagnosis is typically clinical — based on the pattern and appearance of the patches. Dermoscopy (examination of the scalp with a magnifying device) shows characteristic features. Blood tests may be ordered to check for associated autoimmune conditions (thyroid disease is more common in patients with alopecia areata).
A scalp biopsy is occasionally required in unclear cases.
Treatment Options
Corticosteroids: Intralesional steroid injections (directly into the patch) are the most commonly used first-line treatment for patchy alopecia areata, stimulating follicle activity in the treated area. Topical corticosteroids are an alternative for patients unwilling to tolerate injections.
Minoxidil: Topical or oral minoxidil can support regrowth alongside other treatments.
JAK inhibitors: A newer class of medications (oral ruxolitinib, baricitinib) has shown significant efficacy in alopecia totalis and universalis in clinical trials. These represent a major advance for severe cases.
Immunotherapy (DPCP/SADBE): Topical contact immunotherapy — deliberately causing an allergic reaction on the scalp to redirect the immune response — is used in specialist centres for extensive cases.
Is Hair Transplant Suitable for Alopecia Areata?
Hair transplantation is generally not suitable for active alopecia areata. The same immune process that caused the original loss will attack transplanted follicles. The condition must be stable — with no new patches and no active loss — for a minimum of 2 years before transplant is considered.
In patients who have achieved long-term stability (particularly those with isolated, scarring patches from burnt-out disease), transplant can be considered. This requires careful assessment and specialist consultation.
Experiencing patchy hair loss and unsure whether it is alopecia areata? Our team will assess your case and advise on the most appropriate diagnosis pathway and treatment options.