Alopecia areata is one of the most common autoimmune conditions — affecting approximately 2% of the global population at some point in their lives. Understanding what it is, how it differs from pattern hair loss, and what treatments are available is essential for anyone affected.
What Is Alopecia Areata?
Alopecia areata is an autoimmune condition in which the immune system mistakenly attacks hair follicles, causing them to stop producing hair. The follicles are not destroyed — they enter a prolonged resting state. This means the potential for regrowth exists, even after years of loss.
Key characteristics:
- Patchy, often circular or oval areas of hair loss
- Can affect the scalp, beard, eyebrows, and body hair
- The skin in affected areas is typically smooth, without scarring
- Loss can progress, stabilise, or spontaneously regrow — often unpredictably
Extent of Alopecia Areata
- Alopecia areata (patchy): One or more patches of loss
- Alopecia totalis: Complete loss of scalp hair
- Alopecia universalis: Complete loss of all body hair
What Causes Alopecia Areata?
The exact trigger is not fully understood. Genetic susceptibility (specific HLA gene variants) plays a role, as does environmental or psychological stress as a potential trigger. It is not contagious and not caused by diet, hygiene, or external factors.
Treatments for Alopecia Areata
Corticosteroids: Topical, intralesional injections, or systemic corticosteroids suppress the immune response and can stimulate regrowth in many patients.
JAK inhibitors (baricitinib, ruxolitinib): A significant recent advance. JAK inhibitors have shown substantial regrowth rates in clinical trials, including for severe alopecia totalis and universalis. Baricitinib (Olumiant) received FDA approval specifically for severe alopecia areata in 2022.
Minoxidil: Can support regrowth when follicles are transitioning out of dormancy.
Contact immunotherapy (DPCP): A specialist treatment using a sensitising agent to redirect the immune response.
Can Hair Transplant Help with Alopecia Areata?
This is a complex question. The short answer is: sometimes, but only in specific circumstances.
Hair transplantation is generally not appropriate for active alopecia areata because:
- Transplanted grafts may also be attacked by the immune system
- Active disease means ongoing loss — transplanted hair may fall too
- The unpredictable nature of the disease makes outcomes uncertain
Hair transplantation may be considered in patients with:
- Stable, confirmed-inactive alopecia areata for at least 2 years
- Patchy loss (not totalis/universalis)
- No current immune activity on trichoscopy assessment
Even in the best candidates, the risk of recurrence affecting transplanted hair remains. Patients should be fully counselled on this.
Alopecia areata is complex. Our team will assess whether any procedure is appropriate and be honest about what can and cannot be achieved. A thorough medical evaluation is always the first step.