Alopecia areata is an autoimmune condition in which your immune system turns on your own hair follicles, usually leaving smooth, round bald patches that appear suddenly.[1][2] The follicles are not scarred, so hair can grow back, and in many people it does.[3] What no one can promise is when it will return, or whether new patches will follow.
Hair Library · Hair Loss
Alopecia Areata: Causes, Types, Treatment and Regrowth
How alopecia areata starts, which types exist, how the SALT score grades it, what steroids and JAK inhibitors can do, and why a hair transplant is rarely the answer.

Written by Nazmi Güldeş, Certified Trichologist · Medically reviewed by Dr. Teuku Adifitrian, Sp.BP-RE (Dr. Tompi), Plastic, Reconstructive and Aesthetic Surgeon · Last reviewed 30 October 2026
Reading levelWhat Is Alopecia Areata?
Alopecia areata (AA) is an autoimmune disease in which immune cells gather around the roots of growing hair follicles, causing sudden, non-scarring hair loss, most often in round patches on the scalp.[3][1] Nearly 2% of people get it at some point in their lives.[3] Because the follicle survives, hair can regrow, though relapses are common.[4]
How common is it? Pooled international data put the prevalence at 2.1%, yet German data found 0.21% in 2020, and figures differ widely by region.[5] Sudden shedding all over the head has other causes, which our guide to reasons for hair loss walks through.
Signs, Types and Causes of Alopecia Areata
Early Signs and Symptoms
The usual first sign is a well-defined bald patch that appears abruptly, most often on the scalp.[1] In early, active patches, small "exclamation mark" hairs can sit at the edge.[2]
Signs to look for:
- Round, smooth patches with no scarring[2]
- Gaps in the eyebrows, eyelashes or beard[6]
- Nail changes, found in about 30% of people with AA, mostly pitting (20%) and trachyonychia (8%)[7]
- Itch or pain, which in a 400-patient cohort eased as the hair regrew[8]
Brows affected? Read whether eyebrows grow back.
Types of Alopecia Areata
Patchy AA on the scalp is the most common type.[3] The others differ in where, and how much, hair is lost:
- Alopecia totalis: all scalp hair is lost[6]
- Alopecia universalis: scalp, facial and body hair are all lost[6]
- Ophiasis: a symmetric band of loss across the back and sides of the scalp[9], uncommon and slower to regrow than other types[10]
- Alopecia areata incognita: sudden, diffuse thinning without clear patches, which resembles telogen effluvium and usually has a better outlook than other subtypes[11]

What Causes Alopecia Areata?
The leading explanation is a collapse of the follicle's immune privilege, its usual shelter from immune attack, after which immune cells gather around the bulb of follicles in the growth phaseGlossaryAnagen is the growing phase of the hair cycle. For scalp hair it lasts 2 to 6 years according to a Deutsches Ärzteblatt review, and 2 to 7 years according to Cleveland Clinic.
Open in the glossary →.[3][1] Cytotoxic CD8+ T cells drive the damage, and genetic and drug studies point to the JAK/STAT signalling pathway.[1] Genes matter too: AA is a complex, polygenic disease.[3]
AA often travels with other immune conditions. A 2025 meta-analysis of 18 case-control studies found higher odds of vitiligo (odds ratio 6.61), lupus (3.28), atopic dermatitis (2.63) and autoimmune thyroiditis (1.57) in people with AA.[12] Our thyroid hair loss guide covers that link.
Can Stress Cause Alopecia Areata?
Many people tie their first patch to a hard time. When 100 patients were asked about the two years before onset, 82% reported at least one strainful event (unwanted, unexpected and out of their control), most often loss of health or separation. Yet the same authors note that earlier studies on life events and AA reached conflicting results.[13]
Alopecia Areata in Women, Men and Children
Women. Ophiasis, one of the harder types to treat, shows a female predominance.[10]
Men. AA can clear patches in the beard as well as on the scalp.[6]

Children. In 104 patients followed for at least seven years, full or significant regrowth occurred in 74% of childhood-onset cases against 94% of adult-onset cases.[4] Treatment choices are narrower too: the German S3 guideline restricts its strongest systemic recommendations to adults.[14]
Diagnosis and Severity: Alopecia Areata vs Other Hair Loss
How Alopecia Areata Is Diagnosed
Most cases are diagnosed by looking at the hair loss itself.[3] Trichoscopy, a magnified look at the hair and scalp through a dermatoscope, adds detail.[15] A systematic review of 30 studies found yellow dots, short vellus hairsGlossaryVellus hair is the fine, short, pale hair that covers most of the body. It is under 30 micrometres wide and under 2 millimetres long.
Open in the glossary →, black dots (in up to 84%) and exclamation mark hairs, at rates that varied widely between studies.[16]
No single sign proves AA, so doctors look for several together.[16] A scalp biopsy is kept for complex or unusual cases.[2]
The SALT Score: How Severity Is Graded
Doctors grade scalp involvement with the Severity of Alopecia Tool (SALT), a score from 0 (no scalp hair loss) to 100 (complete scalp hair loss).[17] A score of 50 or more has long defined severe disease and the point at which systemic treatment is considered.[18] In treatment trials, success usually means SALT 20 or less: at least 80% of the scalp covered.[19] Newer scales also weigh eyebrow and eyelash loss, emotional burden and treatment response.[18]
Alopecia Areata vs Androgenetic Alopecia and Other Hair Loss
Several conditions share clinical features with AA.[16] This is how they usually differ:
| Condition | How it starts and looks | Clues that set it apart |
|---|---|---|
| Alopecia areata | Sudden, well-defined, non-scarring patches[1] | Yellow dots, black dots, exclamation mark hairs[16] |
| Androgenetic alopecia | Can begin in the teens and progresses in a pattern[20] | Hairs turn finer and shorter under DHT[21] |
| Telogen effluvium | Diffuse, non-scarring shedding[22] | Follows a stress such as childbirth or sudden weight loss[22] |
| Trichotillomania | Loss from hair pulling[23] | Broken hairs of different lengths, flame hairs, V-sign[23] |
| Tinea capitis | Can look like AA[16] | Comma and corkscrew hairs in a study of children[15] |
| Traction alopecia | Loss after tight buns, braids or weaves[24] | Hair casts; can scar if pulling continues[24] |
One small study in children saw black dots only in tinea capitis, while the 30-study review found them in up to 84% of people with AA.[15][16] For pattern hair lossGlossaryAndrogenetic alopecia, or pattern baldness, is the pattern hair loss behind most male and female thinning. It is primarily driven by genetic predisposition and sensitivity to androgen hormones.
Open in the glossary → and the hormone behind it, read our page on DHT and hair loss.
Alopecia Areata Treatment, Regrowth and Hair Transplants
No treatment cures alopecia areata or prevents it. The aim is to calm the disease while it is active.[25]
Patchy Hair Loss: Steroids First
For mild to moderate AA (SALT below 50), first-line treatment is a corticosteroid, applied to the skin or injected into the patch, often alongside topical or oral minoxidilGlossaryMinoxidil is an established medication for certain types of hair loss. It is a drug, not a hair oil, and the FDA-approved label says not to use it for sudden or patchy hair loss.
Open in the glossary →.[18] Because hair can regrow on its own, watching and waiting is reasonable in some cases.[18] How minoxidil itself works is explained in our minoxidil entry.
In a double-blind trial of 105 patients, triamcinolone injections at 2.5, 5 and 10 mg/mL all beat saline over 12 weeks. The strongest dose worked best but thinned the skin most, so the authors suggest starting at 2.5 mg/mL.[26]
Contact immunotherapy with diphenylcyclopropenone (DPCP) or squaric acid dibutyl ester is a preferred treatment for severe AA. Across 45 studies, 65.5% regrew some hair and 32.3% regrew it completely, but 49.0% relapsed without maintenance treatment.[27]
JAK Inhibitors for Severe Alopecia Areata
JAK inhibitors are taken by mouth and block the JAK/STAT pathway behind the immune attack.[1] Three have FDA approval for severe AA:
| Drug | FDA approval for AA | Dose on the label | Main trial result (SALT 20 or less) |
|---|---|---|---|
| Baricitinib (Olumiant) | Adults, 2022[19] | 2 mg once daily; 4 mg if response is not adequate or loss is near total[19] | 38.8% and 35.9% on 4 mg at week 36, against 6.2% and 3.3% on placebo[17] |
| Ritlecitinib (Litfulo) | Age 12 and over, 2023[28] | 50 mg once daily[28] | 23% on 50 mg at week 24, against 2% on placebo[29] |
| Deuruxolitinib (Leqselvi) | Adults, 2024[30] | 8 mg twice daily[30] | 29.6% on 8 mg at week 24, against 0.8% on placebo[31] |
The effect lasts only while you take the drug. When one-year responders were switched to placebo, 80% lost the benefit by week 152, against 7% of those who stayed on baricitinib, and most regained it once they restarted.[32]
All three labels carry a boxed warning about serious infections, death, cancer, major cardiovascular events and blood clots, based partly on another JAK inhibitor in people with rheumatoid arthritis.[19][28][30] In the baricitinib trials, acne, raised creatine kinase and higher cholesterol were more common than on placebo.[17]
A 2026 safety review takes a calmer view: risks seen in older rheumatoid arthritis patients should not be applied directly to well-selected adults with AA.[33]
Clinical detail: why the trial numbers do not rank the drugs
The baricitinib trials measured their main result at week 36 in adults, the ritlecitinib trial at week 24 in patients aged 12 and over, and the deuruxolitinib trial at week 24 in adults aged 18 to 65.[17][29][31]
How Long Does Alopecia Areata Last?
Follow-up studies give a range:
| Time point | What studies found |
|---|---|
| Year 1 | 31.8% of a 400-patient cohort had relapsed, at a median of 28 weeks[8] |
| Years 1 to 4 | 79% of relapses happened within the first four years[4] |
| Year 7 and later | Full or significant regrowth in 74% of childhood-onset, 94% of adult-onset and 100% of late-onset cases[4] |
| Years 15 to 22 | 68.3% of patients with the mildest disease at their first visit were free of AA, while 36.1% of the whole group had totalis or universalis[34] |
The two long studies differ because they followed different people: 63 of the 191 patients in one had severe disease at the start, which predicted the outcome[34], while 88.5% in the other had mild disease at their first episode.[4]
Regrowth Signs to Look For
On trichoscopy, upright regrowing hairs signal new growth.[16] The first new hairs are often white; this is usually temporary, but in some people the white hair stays.[35]
Can You Have a Hair Transplant With Alopecia Areata?
A hair transplant is generally not a treatment for active alopecia areata. The sources point to four reasons:
- The follicles are still there. AA preserves the follicle, so hair in a patch can regrow without surgery.[3]
- The disease comes back. Relapses affected 44% of adult-onset and 52% of childhood-onset patients in one long follow-up.[4]
- Grafts are not protected. In one man with eyebrow AA, a transplant gave eight months free of the disease before it returned in the brow.[36]
- Injury can set off new patches. In people with relapsing AA, plucking hairs for a trichogram test was followed by new patches within 1 to 7 days.[37]
The few successes come from stable disease. In a man whose eyebrow AA had resisted treatment and had been stable for 18 months, eyebrow grafts taken by FUE reached 80% regrowth at two years. Even so, the authors call surgery for AA controversial.[38] Both cases involved an eyebrow transplant.[38][36]
Frequently Asked Questions
Is alopecia areata an autoimmune disease?
Can alopecia areata be cured?
Does hair grow back after alopecia areata?
Is alopecia areata genetic?
Is alopecia areata contagious?
Does alopecia areata spread?
Does alopecia areata come and go?
Treatment, Waiting or Surgery: What Suits You?
Alopecia areata is a medical condition first. If your patches are new or spreading, see a dermatologist: treatments from steroid injections to JAK inhibitors now have trial evidence.[18][17] The German S3 guideline also recommends telling everyone with AA about hair replacement and cosmetic options.[14] A transplant suits only a small group with long-stable disease, and even then AA can return.[38][36]
Not sure whether your loss is alopecia areata or pattern hair loss that a transplant could treat? Send three photos for a free hair analysis, and the medical team will tell you which it looks like and whether to see a dermatologist first. You can also message us on WhatsApp.
About the Author
Written by: Nazmi Güldeş, Certified Trichologist. Nazmi Güldeş focuses on patient education around androgenetic alopecia, evaluating miniaturization through dermoscopy, and assessing candidates for medical treatments and hair transplants.
Editorial Policy & Trust
This entry was drafted with the help of AI writing tools and edited by our team, then medically reviewed by Dr. Teuku Adifitrian, Sp.BP-RE (Dr. Tompi) on 30 October 2026. AI is never used as a source: every study cited here was checked against PubMed on 30 October 2026, and each claim sits next to the study that supports it. Read how we work in our editorial policy.
Test yourself
Check what you remember from this entry. Each answer links back to the section that explains it.
- Which SALT score usually counts as success in alopecia areata treatment trials?
SALT 20 or less means at least 80% of the scalp is covered; 50 or more has long defined severe disease. Read the section
- What happened when one-year baricitinib responders were switched to placebo?
80% lost the benefit by week 152, against 7% of those who stayed on baricitinib; most regained it after restarting. Read the section
- Why is a hair transplant generally not used for active alopecia areata?
AA preserves the follicle, relapses are common, and in one eyebrow case the disease returned in the grafts after eight months. Read the section
Evidence behind this entry: 36 publications indexed in PubMed (2005 to 2026): 11 reviews, 7 clinical studies, 5 guidelines, 5 randomized trials, 4 case reports and 4 systematic reviews. Plus the FDA prescribing information for Olumiant (baricitinib), Litfulo (ritlecitinib) and Leqselvi (deuruxolitinib). 12 sources have free full text. 1 article has a published correction, shown in the references.
- Randomized trialpeople assigned to treatments by chance
- Reviewsummarises many studies
- Clinical studya study in people without random groups
- Guideline or labela professional body, or the official drug label
Every source checked against PubMed on 30 October 2026, including corrections and retractions. See the newest studies on PubMed →
References
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- Spano F, Donovan JC. Alopecia areata: Part 1: pathogenesis, diagnosis, and prognosis. Canadian Family Physician Medecin de Famille Canadien. 2015;61(9):751-755.ReviewPubMedFree full text
- Pratt CH, King LE Jr, Messenger AG, et al. Alopecia areata. Nature Reviews Disease Primers. 2017;3:17011.ReviewPubMedDOIFree full text
- Lyakhovitsky A, Aronovich A, Gilboa S, et al. Alopecia areata: a long-term follow-up study of 104 patients. Journal of the European Academy of Dermatology and Venereology. 2019;33(8):1602-1609.Clinical studyPubMedDOI
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Güldeş, N. (2026, October 30). Alopecia areata: Causes, types, treatment and regrowth. Turkey Hair Center Hair Library. https://turkeyhaircenter.com/alopecia-areata/
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