Alopecia areata: causes, treatment and regrowth

In short: alopecia areata is an autoimmune condition: the immune system attacks hair follicles, causing round, smooth bald patches on the scalp, beard, eyebrows or elsewhere. It isn't contagious, and it isn't caused by anything you did. The follicles aren't destroyed, so hair can grow back. Many small patches regrow on their own, but it can come back. See a dermatologist: several treatments work, and newer ones help even extensive cases.

What it looks like

Round or oval patches of completely smooth skin, often the size of a coin
Appear over days or weeks, sometimes with a tingle or itch beforehand
Short broken hairs at the edges that taper at the base ("exclamation-mark hairs")
Can affect the beard, eyebrows and eyelashes
Sometimes small dents (pitting) in the nails
Regrowing hair may come in white or grey at first, then darken

Types

Type	What happens
Patchy (most common)	One or more round patches
Beard (alopecia barbae)	Patches in the beard
Ophiasis	A band of loss around the sides and back of the head; harder to treat
Totalis	Loss of all scalp hair
Universalis	Loss of all body hair
Diffuse	Sudden all-over thinning; can be mistaken for telogen effluvium

Causes and risk factors

The immune system mistakenly targets the hair follicle. Genes play a role.
More likely if you or your family have: thyroid disease, vitiligo, eczema, asthma, hay fever, or other autoimmune conditions.
Stress may trigger flares in some people, but it isn't the root cause. → Stress and hair loss
It can start at any age, often in childhood or young adulthood.

Will it grow back?

Single, small patches often regrow within months to a year, even without treatment.
Relapses are common. New patches may appear later.
Harder to treat: large or many patches, ophiasis, totalis or universalis, onset in early childhood, nail changes, a long duration, or a strong history of eczema.

Treatment overview

Extent	Common options
A few small patches (adults)	Steroid injections into the patch every 4–6 weeks (often triamcinolone); strong steroid creams or lotions
Children	Steroid creams; injections only in selected older children
Many patches / extensive	Contact immunotherapy (e.g. DPCP); oral steroids for short periods; immune-modulating medicines
Severe (≥50% loss), totalis, universalis	JAK inhibitors (baricitinib, ritlecitinib, deuruxolitinib, depending on approval and availability)
Add-ons	Minoxidil to support regrowth

→ Full detail, costs and side effects: Alopecia treatments in India

Ayurveda, homeopathy and home remedies: we couldn't find good-quality evidence that these regrow hair in alopecia areata beyond what happens naturally. Because many patches regrow on their own, it's easy to credit whatever was tried. If you choose them, don't delay seeing a dermatologist for spreading patches.

Living with it

Hair alternatives: wigs, toppers, eyebrow tinting or microblading, and false eyelashes help many people.
Emotional support: alopecia areata can be hard, especially for children and teenagers. Talk to your doctor, or call Tele-MANAS on 14416. Patient communities can help (coming in our community).
Sun protection for bare scalp skin.

When to see a doctor

Always for a first episode, to confirm the diagnosis. Patchy hair loss has other causes, including fungal infection (tinea capitis), which needs different treatment, especially in children. → Patchy hair loss: causes

See a doctor soon if you have: round bald patches that appear suddenly · hair coming out in clumps · redness, pain, pus, scaling or scarring on the scalp · hair loss with fever, weight loss, irregular periods, acne or new facial hair · eyebrow or eyelash loss · hair loss in a child.

Sources

Strazzulla LC, et al. Alopecia areata: disease characteristics, clinical evaluation, and new perspectives on pathogenesis. J Am Acad Dermatol. 2018;78:1–12.
King B, et al. Two phase 3 trials of baricitinib for alopecia areata. N Engl J Med. 2022;386:1687–99.

Medical review pending: not yet reviewed by a dermatologist. Medical disclaimer