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Alopecia Areata

Autoimmune Hair Loss — Sudden Patchy Bald Spots

~2% of people
Affects
worldwide
Autoimmune
Type
immune attacks follicles
Any age
Onset
often before 30
~50%
Regrowth
spontaneous in 1yr

What is Alopecia Areata?

Alopecia areata is an autoimmune condition where the immune system attacks hair follicles, causing sudden hair loss in round patches. It can affect the scalp, eyebrows, eyelashes, or any hair-bearing area. The severity varies widely — from a single small patch to complete loss of all body hair.

Unlike androgenetic alopecia, the hair follicles are not destroyed — they are suppressed by the immune response. This means regrowth is possible if the immune attack subsides, either spontaneously or with treatment.

Types of Alopecia Areata

Alopecia Areata (Patchy)

Mild-Moderate

One or more round, smooth bald patches on the scalp. Most common form. May resolve spontaneously.

Alopecia Totalis

Severe

Complete loss of all hair on the scalp. More challenging to treat, but new JAK inhibitors show promise.

Alopecia Universalis

Most Severe

Complete loss of all body hair, including scalp, eyebrows, eyelashes, and body hair. Rarest and most extensive form.

Ophiasis Pattern

Moderate-Severe

Hair loss in a band shape around the sides and back of the head. Named after the Greek word for snake. More resistant to treatment.

Diffuse Alopecia Areata

Variable

Sudden overall thinning across the scalp rather than distinct patches. Can be confused with telogen effluvium.

Treatment Options

Corticosteroid Injections

First-line for mild cases

Injected directly into bald patches every 4-6 weeks. Most effective for a few small patches. Response rates of 60-70%.

JAK Inhibitors (Baricitinib, Ritlecitinib)

FDA-approved 2022-2023

FDA-approved oral medications that block the immune signaling attacking follicles. ~35-40% achieve 80%+ scalp coverage. Breakthrough treatment.

Topical Immunotherapy (DPCP/SADBE)

Specialist-administered

Intentionally causes an allergic reaction to distract the immune system. Applied weekly. Can be effective for extensive cases.

Topical Corticosteroids

OTC or prescription

Creams or ointments applied to patches. Less effective than injections but useful for children or those who prefer non-injection treatment.

Minoxidil (Adjunct)

Complementary

May speed up regrowth when used alongside other treatments. Not effective on its own for alopecia areata but can complement other therapies.

Signs It May Be Alopecia Areata

  • Sudden appearance of smooth, round bald patch(es)
  • "Exclamation point" hairs — short broken hairs that taper at the base
  • Nail changes — pitting, ridges, or brittleness (in ~10-20% of cases)
  • Tingling or burning sensation before hair falls out
  • White or gray hairs growing back first in previously bald patch

Frequently Asked Questions

Will my hair grow back with alopecia areata?

In many cases, yes. About 50% of people with mild alopecia areata (a few small patches) see spontaneous regrowth within a year without treatment. However, alopecia areata is unpredictable — hair may regrow and then fall out again. More extensive forms (totalis/universalis) have lower spontaneous regrowth rates.

What causes alopecia areata?

Alopecia areata is an autoimmune condition where the immune system mistakenly attacks hair follicles. The exact trigger is unknown but involves a combination of genetic predisposition and environmental factors (stress, infections, etc.). Having one autoimmune condition increases the risk of developing others.

Is alopecia areata hereditary?

There is a genetic component — about 10-20% of people with alopecia areata have a family member with the condition. However, having the genes doesn't guarantee you'll develop it. Identical twin studies show only ~55% concordance, meaning environmental triggers also play a significant role.

What are the new FDA-approved treatments?

JAK inhibitors (Janus kinase inhibitors) represent a breakthrough for alopecia areata. Baricitinib (Olumiant) was FDA-approved in 2022 and ritlecitinib (Litfulo) in 2023 for severe alopecia areata. These oral medications can produce significant regrowth in many patients. Clinical trials show ~35-40% of patients achieve 80%+ scalp coverage.

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