Alopecia areata
Last reviewed
Alopecia areata is an autoimmune condition where the immune system attacks hair follicles, producing smooth, well-defined circular bald patches — usually on the scalp, sometimes on the beard or eyebrows. Most patches regrow on their own or with treatment; topical or intralesional corticosteroids, minoxidil and newer JAK inhibitors all have a role. Early treatment helps more than late treatment.
Alopecia areata typically appears suddenly — a coin-sized, smooth round patch noticed during a haircut or in a photograph. The skin underneath looks completely normal, no scaling or redness, which makes it easy to miss until someone else points it out.
It is not contagious, not caused by stress alone, and not a sign of an underlying scalp disease in most cases. It is an autoimmune condition with periods of activity and remission, and the most important factor in good outcomes is starting treatment while patches are still small.
How alopecia areata shows up
- Smooth, well-defined circular bald patches — usually 1–5 cm across
- No scaling, redness or itching in most cases
- 'Exclamation mark' hairs at the edge of an active patch — short, tapered hairs that are diagnostic
- Most commonly on the scalp; can affect beard, eyebrows, eyelashes, body hair
- Occasional nail changes — pitting, ridging, roughness
- Patches that join into larger areas (alopecia totalis or universalis in severe cases)
- Recurrent episodes — many patients have a flare-remit pattern over years
What's known about the cause
- Autoimmune — T-cell attack on the hair follicle's stem-cell niche
- Genetic predisposition — family history in 10–20% of cases
- Trigger associations — viral illness, vaccination (rare), severe stress events
- Higher prevalence with other autoimmune conditions (thyroid disease, vitiligo, type 1 diabetes)
- No causal link to washing frequency, oils, diet or shampoo
When to see a dermatologist
See a dermatologist as soon as a patch is noticed — even one. Alopecia areata is most responsive to treatment when patches are small and recent. Patients who wait six months or a year usually face a longer treatment course and a higher chance of recurrence.
How alopecia areata is treated at SkinWise
Treatment is matched to extent and activity. Single small patches respond well to intralesional corticosteroid injections every 4–6 weeks. Multiple patches may add topical corticosteroids, topical immunotherapy or minoxidil. Extensive or rapidly spreading disease is now treatable with oral JAK inhibitors (baricitinib, ritlecitinib) — a real advance for severe cases that previously had few options.
Services that treat alopecia areata
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Frequently asked questions
Will my hair grow back?
Most single small patches regrow within 6–12 months, with or without treatment. Larger or recurrent patterns have variable outcomes — treatment helps, but a long-term flare-remit pattern is common. We discuss realistic expectations at the first consult.
Is alopecia areata caused by stress?
Stress can be a trigger for some patients, especially around a flare, but it isn't the underlying cause. The condition is autoimmune; stress-management is helpful as one input but won't replace medical treatment.
Are the steroid injections painful?
There's a brief sting at each injection site. We use a fine needle and small volumes; most patients tolerate a 4–6 patch session comfortably. Numbing cream is available if needed.
What about JAK inhibitors — are they safe?
Oral JAK inhibitors (baricitinib, ritlecitinib) are now approved for severe alopecia areata and represent a real treatment advance. They need monitoring (blood counts, lipid profile) and aren't first-line for limited disease, but for extensive or rapidly progressing cases they can be transformative.
Ready to start with a consult?
A focused 15-minute first consultation is where we slow down, map your concern and build the smallest plan that will actually move the needle. No oversell, no fixed menu.