Source: NIAMS, AAD, Cleveland Clinic

• What is alopecia areata?
• Symptoms of alopecia areata
• Causes and risk factors
• Types of alopecia areata
• How alopecia areata is diagnosed
• Treatment options for alopecia areata
• Outlook: will my hair grow back?
• Complications and related conditions
• Prevention and living with alopecia areata
• When to see a doctor
• FAQ
• Sources

What is alopecia areata?

Alopecia areata is an autoimmune disease in which the body’s own immune system attacks hair follicles, the tiny structures in the skin that produce hair. The result is hair loss that usually starts suddenly, most often as one or more smooth, round or oval bald patches on the scalp. The name describes the condition well: alopecia means hair loss and areata means patchy. Any hair-bearing area can be affected, including the beard, eyebrows, eyelashes and body hair.

Source: NIAMS, AAD

The immune attack stops the follicles from producing hair, but it does not destroy them. Because the follicles stay alive, hair can grow back, sometimes on its own and sometimes with treatment. This is a key difference from scarring forms of hair loss. Alopecia areata is not contagious: you cannot catch it from or pass it to another person.

Source: MedlinePlus Genetics, AAD, Cleveland Clinic

How common is it?

Alopecia areata is the second most common form of hair loss after male and female pattern hair loss (androgenetic alopecia). Figures vary by source and by how they are counted. MedlinePlus Genetics estimates that about 1 in 500 to 1,000 people in the United States are affected at a given time, while DermNet and the National Alopecia Areata Foundation (NAAF) put the lifetime risk at about 2%. NAAF estimates that nearly 7 million people in the US, and about 160 million worldwide, have had, have or will have the condition.

Source: MedlinePlus Genetics, DermNet, NAAF, Cleveland Clinic

It affects men and women about equally and occurs in people of every skin tone and ethnic background. It can begin at any age, but most people first notice it as children, teenagers or young adults; NIAMS notes that onset is most common in the teens, twenties and thirties. Cleveland Clinic reports that about 20% of people with alopecia areata are children.

Source: NIAMS, AAD, MedlinePlus Genetics, Cleveland Clinic

Symptoms of alopecia areata

The typical first sign is a sudden, smooth bald patch, often about the size of a coin. The skin inside the patch usually looks normal, with no scarring, rash or flaking, although some people notice tingling, burning or itching just before the hair falls out. Patches may be small and hidden under longer hair or large enough to be obvious.

Source: NIAMS, AAD, Cleveland Clinic

Common signs

• Round or oval bald patches on the scalp, beard area, eyebrows, eyelashes or body
• “Exclamation mark” hairs: short, broken hairs that are narrower at the base, seen at the edges of a patch
• Black dots (broken hairs at the skin surface) and, less often, sudden whitening of the hair
• Diffuse thinning across the scalp instead of distinct patches (in the diffuse type)
• Regrowth that comes back white or fine at first before regaining its normal color and texture

Source: NIAMS, Cleveland Clinic, DermNet, AAD

Nail changes

Nails can be involved too. The most common change is pitting, tiny dents in the nail surface, along with ridging or roughness. DermNet reports nail changes in roughly 10–40% of patients, and they tend to be more frequent in people with more extensive hair loss.

Source: DermNet, NIAMS, Cleveland Clinic

Apart from the hair and nails, most people with alopecia areata feel physically well. The condition does not cause pain or physical disability, but sudden, unpredictable hair loss can strongly affect self-image and emotional wellbeing.

Source: NIAMS, NIAMS, NAAF

Causes and risk factors

In alopecia areata, immune cells mistakenly target growing hair follicles and cause inflammation around them. Researchers do not yet fully understand what sets off this attack. The current view is that a combination of genetic susceptibility and environmental factors is responsible.

Source: NIAMS, MedlinePlus Genetics

Genetics

Many of the genes linked to alopecia areata help regulate the immune system, especially genes of the HLA complex, which helps the body tell its own proteins from foreign ones. Having a first-degree relative with the condition raises your risk. NAAF reports that about 20% of people with alopecia areata have a family member with it, and that if one identical twin is affected, the other has about a 55% chance of developing it, which shows that genes matter but are not the whole story.

Source: MedlinePlus Genetics, NAAF

Risk factors

• A family history of alopecia areata or of other autoimmune diseases
• Other autoimmune conditions such as thyroid disease, vitiligo, lupus, psoriasis or type 1 diabetes
• Allergic (atopic) conditions such as eczema (atopic dermatitis) and hay fever
• Down syndrome and some other chromosomal conditions
• Being a child or young adult

Source: NIAMS, Cleveland Clinic, DermNet, MedlinePlus Genetics

What about stress?

Emotional stress, illness or injury may act as a trigger in people who are already susceptible, and many patients recall a stressful event before their first patch. However, stress has not been proven to cause alopecia areata, and in most cases no clear trigger is found.

Source: NIAMS, MedlinePlus Genetics, Cleveland Clinic

Types of alopecia areata

Doctors describe alopecia areata by the pattern and extent of hair loss. One person can move between types over time, for example when small patches join together.

Source: NIAMS, AAD

Type	What it looks like
Patchy alopecia areata	One or more coin-sized bald patches; the most common type
Alopecia barbae	Patchy hair loss in the beard area
Ophiasis	A band of hair loss along the sides and lower back of the scalp
Diffuse alopecia areata	Sudden thinning over the whole scalp rather than patches
Alopecia totalis	Loss of all, or nearly all, scalp hair
Alopecia universalis	Loss of all, or nearly all, hair on the scalp, face and body; rare

Source: AAD, Cleveland Clinic, NIAMS, DermNet

According to Cleveland Clinic, about 5% of people with alopecia areata develop alopecia totalis and about 1% develop alopecia universalis; DermNet estimates that roughly 5–10% of cases progress to one of these extensive forms. Dermatologists often measure severity with the SALT score (Severity of Alopecia Tool), which records the percentage of scalp hair lost. A SALT score of 40 or more, meaning at least 40% of the scalp is bare, is generally regarded as severe.

Source: Cleveland Clinic, DermNet

How alopecia areata is diagnosed

Diagnosis is usually clinical, which means a doctor can often recognize alopecia areata simply by examining the bald areas and nails and asking about your medical and family history. Dermatologists, specialists in skin, hair and nail conditions, are the doctors who most often diagnose and treat it.

Source: NIAMS, Cleveland Clinic

• Trichoscopy (dermoscopy): a handheld magnifier shows typical features such as exclamation mark hairs, yellow dots, black dots and broken hairs
• Hair pull test: gently pulling a small bunch of hairs; it is considered positive if more than 10% come out easily, which suggests active hair loss
• Scalp biopsy: a small skin sample, used when the diagnosis is unclear; active disease shows a “bee-swarm” pattern of immune cells around the follicles
• Blood tests and scalp checks: to look for thyroid disease, other autoimmune problems or a fungal scalp infection

Source: NIAMS, DermNet, Cleveland Clinic

Conditions that can look similar

Several other conditions can cause patchy or sudden hair loss and need to be ruled out. These include trichotillomania (hair pulling), fungal scalp infection (tinea capitis), telogen effluvium, androgenetic alopecia, scarring alopecias such as lichen planopilaris and frontal fibrosing alopecia, discoid lupus of the scalp and secondary syphilis. This is why an accurate diagnosis by a doctor matters before choosing any treatment.

Source: DermNet

Treatment options for alopecia areata

There is no cure for alopecia areata, but several treatments can help hair regrow faster and calm the immune attack. Choice of treatment depends on age, how much hair has been lost, how long the episode has lasted and personal preference. Many people with one or two small patches regrow hair without treatment, so a dermatologist may recommend watchful waiting first. Others with extensive loss choose not to be treated and use wigs or other cosmetic options instead.

Source: NIAMS, AAD, AAD

Corticosteroids

Corticosteroid injections into the bald patches are the most commonly used treatment for patchy alopecia areata in adults. According to the AAD, they are usually repeated every 4 to 6 weeks, and when they work, regrowth tends to appear within about 3 months of the first injection. They are generally not used in young children because they are painful. Topical corticosteroids (creams, lotions or foams) are an option for children and for people who do not want injections. Short courses of oral corticosteroids such as prednisone are sometimes used for extensive or rapidly spreading loss, but side effects limit long-term use.

Source: AAD, NIAMS, NHS, Cleveland Clinic, DermNet

Minoxidil and anthralin

Topical minoxidil is often added to help maintain regrowth; the AAD notes it has few side effects, which makes it a reasonable option for children. Cleveland Clinic says growth typically takes about 12 weeks to appear. Anthralin (dithranol) is a cream applied to bald spots for a short time and then washed off; it irritates the skin on purpose and can trigger regrowth.

Source: AAD, Cleveland Clinic, DermNet

JAK inhibitors for severe alopecia areata

Janus kinase (JAK) inhibitors are pills that block immune signals involved in the attack on hair follicles, and they are the first medicines approved specifically for severe alopecia areata. Three are available in the US: baricitinib (approved for adults with severe disease according to MedlinePlus; the AAD page lists it for patients 12 and older), ritlecitinib (approved for people aged 12 and older with extensive hair loss) and deuruxolitinib (approved for adults with severe disease). They do not work for everyone, they are expensive, and they require medical monitoring.

Source: AAD, MedlinePlus, NIAMS, DermNet, NAAF

Other treatments

• Contact (topical) immunotherapy, such as diphenylcyclopropenone, which causes a mild allergic rash to redirect the immune response; it needs weekly visits, and the AAD reports success rates from 17% to 75%
• Other immune-suppressing tablets such as methotrexate or cyclosporine for extensive disease
• Light therapy (phototherapy), sometimes combined with psoralen
• Platelet-rich plasma (PRP) injections, which have been reported to help some patients, though the evidence is limited
• Eyelash and eyebrow options such as bimatoprost for lashes, steroid injections for brows, or JAK inhibitors when loss is extensive

Source: AAD, Cleveland Clinic, DermNet, NHS

Is a hair transplant an option?

A hair transplant is usually not a suitable treatment for alopecia areata. The NHS states that transplants are mainly for permanent, inherited baldness and are not usually suitable for the patchy hair loss of alopecia areata. Because the condition is driven by the immune system and can relapse, transplanted follicles may also be affected, and hair often regrows on its own anyway. People who have both alopecia areata and male pattern baldness should discuss options with a dermatologist first. For inherited hair loss, a specialised hair-transplant centre such as Hair Cultivate can assess whether surgery is appropriate. You can also read our guide to hair transplant in Turkey.

Source: NHS, NHS, AAD

Outlook: will my hair grow back?

The course of alopecia areata is unpredictable. In most people hair regrows, often within months to about a year, but new patches can appear while old ones are recovering, and relapses are common. The AAD notes that many people relapse within a year of regrowth and that most relapses happen within 5 years. Some people have a single episode in their life; others have repeated episodes for years.

Source: NIAMS, AAD, MedlinePlus Genetics

Factors linked to a less favorable outlook

• Onset in childhood, especially before age 10
• More extensive hair loss, including totalis or universalis
• Hair loss lasting more than a year
• Nail changes
• The ophiasis (band) pattern
• A family history of alopecia areata, or atopy and other autoimmune diseases

Source: DermNet, NIAMS

Regrowth is more likely when hair loss is limited, starts later in life, and comes without nail changes or a family history. With treatment, some people see early regrowth within about 6 weeks, but full regrowth usually takes months, and some people do not get the result they hoped for.

Source: NIAMS, AAD, Cleveland Clinic

Complications and related conditions

Alopecia areata does not damage general physical health, but it is linked to several other problems. The biggest burden is often emotional: anxiety, depression and stress are more common in people with the condition, and the unpredictable cycle of loss and regrowth can affect confidence, work and relationships.

Source: Cleveland Clinic, NIAMS, NAAF

• Other autoimmune diseases, especially thyroid disease and vitiligo, as well as atopic dermatitis; regular check-ups help detect them early
• Nail pitting and roughness
• Sunburn and cold on bare scalp skin
• Eye irritation from dust and debris when eyelashes or eyebrows are lost
• Side effects of treatment, such as weight gain, mood changes or blurred vision with corticosteroids, or skin irritation with topical therapies

Source: NIAMS, Cleveland Clinic, DermNet

Prevention and living with alopecia areata

There is no known way to prevent alopecia areata. Living with it is mostly about protecting bare skin, choosing cosmetic options that feel right, and looking after your mental health.

Source: Cleveland Clinic, NIAMS

• Use sunscreen on bare skin and wear hats or scarves to protect the scalp from sun and cold
• Wear glasses or sunglasses if you have lost eyebrows or eyelashes
• Consider wigs, hairpieces or bandanas; some people shave their head to even out patchy loss. The NHS notes synthetic wigs last about 6 to 9 months and real-hair wigs about 3 to 4 years
• Use false eyelashes, stick-on or tattooed eyebrows, makeup or semi-permanent microblading, which the AAD says lasts about 6 months to a year
• Avoid harsh chemical hair treatments such as chemical straighteners and perms
• Eat a balanced diet and keep regular primary care visits to screen for related conditions
• Connect with support groups or a mental health professional if hair loss affects your mood

Source: NIAMS, Cleveland Clinic, NHS, AAD, NAAF

When to see a doctor

See a doctor or dermatologist as soon as you notice unexplained patchy hair loss, so that other causes such as a scalp infection can be ruled out and treatment can start early if needed. Go back to your doctor if new symptoms appear during treatment, if the hair loss keeps spreading, or if there is no improvement.

Source: Cleveland Clinic, NHS, NIAMS

Source: Cleveland Clinic

Related treatments

Related conditions

Further reading

Alopecia areata: frequently asked questions

Sources

1. NIAMS — Alopecia Areata
2. NIAMS — Alopecia Areata: Diagnosis, Treatment, and Steps to Take
3. AAD — Hair loss types: Alopecia areata overview
4. AAD — Hair loss types: Alopecia areata diagnosis and treatment
5. Cleveland Clinic — Alopecia Areata: Symptoms, Causes, Treatment & Regrowth
6. MedlinePlus Genetics — Alopecia areata
7. MedlinePlus — Baricitinib
8. DermNet — Alopecia Areata: Causes, Diagnosis, and Treatment
9. NAAF — Alopecia Areata
10. NHS — Hair loss
11. NHS — Hair transplant

This page is part of the Morepital medical reference. It is for general health education and does not replace a consultation with a qualified doctor. Last reviewed: October 2026.