Alopecia areata is an autoimmune disease in which immune cells target the hair follicle, interrupting the normal hair growth cycle.

The exact cause is unknown, but several factors are thought to contribute, including:

• ·Genetic predisposition

• Autoimmune disease

• Viral illnesses

• Physical or emotional stress (may act as a trigger in some people)

People with alopecia areata have a slightly increased risk of other autoimmune conditions, particularly:

• Thyroid disease

• Vitiligo

• Atopic eczema

• Type 1 diabetes

• Pernicious anaemia

Most people with alopecia areata are otherwise healthy.

The most common presentation is the sudden appearance of one or more round or oval bald patches on the scalp.

Other symptoms may include:

• Smooth patches of hair loss

• Hair loss affecting the beard

• Loss of eyebrows

• Loss of eyelashes

• Hair shedding over several days or weeks

• Mild tingling or itching before hair falls out (occasionally)

Unlike many other causes of hair loss, the skin usually appears completely normal.

There are several forms of alopecia areata.

Patchy alopecia areata

The most common type, causing one or several well-defined bald patches.

Alopecia totalis

Complete loss of scalp hair.

Alopecia universalis

Complete loss of scalp and body hair, including eyebrows, eyelashes and beard hair.

Ophiasis alopecia

Hair loss occurring around the sides and back of the scalp. This form is often more resistant to treatment.

Diffuse alopecia areata

Rather than distinct patches, some people develop widespread thinning across the scalp.

Approximately 10–20% of patients develop nail abnormalities.

These may include:

• Nail pitting

• Rough nails

• Longitudinal ridging

• Brittle nails

• Thinning of the nails

Nail involvement sometimes indicates more extensive disease.

Diagnosis is usually made during a consultation with a Specialist Dermatologist.

Assessment may include:

• Medical history

• Family history

• Examination of the scalp

• Dermoscopy (trichoscopy)

Characteristic dermoscopic features include:

• Exclamation mark hairs

• Yellow dots

• Black dots

• Broken hairs

• Short regrowing hairs

Blood tests may occasionally be recommended if an associated autoimmune condition is suspected.

A scalp biopsy is rarely required.

Treatment depends on:

• Age

• Severity

• Duration of hair loss

• Extent of scalp involvement

• Previous treatments

Because every patient is different, treatment is individualised.

Options may include:

• Corticosteroid injections into affected areas

• Potent topical corticosteroids

• Topical immunotherapy (selected patients)

• Topical minoxidil

• Oral medications in selected cases

• Newer JAK inhibitor medications for severe disease

For adults with limited patchy alopecia areata, corticosteroid injections into the scalp are considered one of the most effective first-line treatments.

Small amounts of corticosteroid are injected directly into the affected skin every 4–6 weeks to reduce inflammation around the hair follicles.

Many patients begin noticing regrowth within 6–12 weeks, although several treatment sessions are often required.

In recent years, Janus kinase (JAK) inhibitors have transformed the treatment of severe alopecia areata.

These medications work by blocking the abnormal immune signals responsible for attacking the hair follicle.

JAK inhibitors may be considered for patients with:

• Extensive scalp involvement

• Alopecia totalis

• Alopecia universalis

• Disease that has not responded to conventional treatment

Your dermatologist will discuss whether these medications are appropriate for your individual circumstances.

The course of alopecia areata is unpredictable.

Some patients experience spontaneous regrowth within several months, while others have repeated episodes over many years.

Several factors influence prognosis, including:

• Age at onset

• Extent of hair loss

• Nail involvement

• Duration of disease

• Family history

Even after successful treatment, future episodes can occur.

Hair loss can have a significant emotional impact, particularly when it affects visible areas such as the scalp, eyebrows or eyelashes.

Many patients benefit from:

• Early treatment

• Cosmetic camouflage

• Scalp micropigmentation (selected patients)

• Wigs or hairpieces

• Psychological support if required

Your dermatologist can discuss options that best suit your individual situation.

Our Specialist Dermatologists have experience diagnosing and managing all forms of alopecia areata.

We offer:

• Comprehensive assessment

• Trichoscopy (dermoscopic scalp examination)

• Corticosteroid injections

• Prescription topical medications

• Assessment for JAK inhibitor therapy

• Investigation for associated autoimmune conditions

• Long-term follow-up and monitoring

Our aim is to diagnose alopecia areata early, maximise the opportunity for hair regrowth and support patients throughout their treatment journey.