The Best Hair Transplant Surgeons in the World: 2026 AHLA Guide
INTRODUCTION Medically reviewed by Aron G. Nusbaum, M.D., FAAD – April 28, 2026 There
Alopecia Areata
Alopecia areata, often abbreviated AA, is a chronic immune mediated disease in which the immune system mistakenly targets hair follicles and disrupts normal hair growth. It is a nonscarring form of hair loss, meaning the follicles are generally not permanently destroyed and may retain the ability to produce hair again.
Alopecia areata can affect children and adults of any age and may involve the scalp, beard, eyebrows, eyelashes or other body hair. The most familiar presentation is the sudden appearance of one or more smooth, round or oval patches of hair loss. Short broken hairs that taper near the scalp, often called exclamation point hairs, may sometimes be seen around active areas. Some people also develop changes in the fingernails or toenails, including small pits or ridges.
The condition is fundamentally different from androgenetic alopecia, telogen effluvium and the primary scarring alopecias. In alopecia areata, the defining process is an abnormal immune response directed at the hair follicle rather than progressive follicular miniaturization, disruption of the normal hair cycle or permanent follicular destruction from scarring.
The biology of alopecia areata is complex. Research has identified strong genetic involvement together with immune pathways that help explain why certain individuals become susceptible to the disease. Environmental factors may influence when the condition becomes active, but in many patients no specific trigger can be identified.
Alopecia areata is not contagious and is not caused by infection, poor hygiene or routine hair care practices. The disease can become active without warning, and the location and extent of hair loss may change over time. Scalp involvement alone also does not always reflect the full burden of the disease, particularly when eyebrows, eyelashes, facial hair or other body hair are affected.
Alopecia areata has also been associated with other immune and allergic conditions, including autoimmune thyroid disease, vitiligo and atopic disease. These associations do not mean that every person with alopecia areata will develop another condition, but they can be relevant during medical evaluation.
The emotional burden can be profound. Sudden loss of scalp hair, eyebrows, eyelashes or facial hair can affect self image, confidence, social interaction and quality of life. For that reason, disease severity should never be judged only by the percentage of scalp hair that has been lost.
Alopecia areata can occur in several recognizable patterns. When all or nearly all scalp hair is lost, the condition is called alopecia totalis. When hair loss involves the scalp and essentially all body hair, including eyebrows and eyelashes, it is known as alopecia universalis. Hair loss confined primarily to the beard is called alopecia barbae. Another pattern, alopecia ophiasis, produces a band of hair loss around the sides and back of the scalp.
Hair loss can develop rapidly, sometimes over a period of days or weeks. Affected areas often appear smooth and normal in color without the obvious scaling or surface inflammation seen in many other scalp disorders. Some people experience itching, tingling, burning or tenderness before or during an active episode, while others notice no sensation at all.
Because the follicles generally remain intact, spontaneous regrowth is possible. People with one or a small number of patches may experience complete regrowth without treatment, while others develop repeated cycles of hair loss and regrowth or more extensive persistent disease. Newly growing hair may initially appear finer or lighter in color before returning closer to its previous appearance.
Alopecia areata has historically been blamed on emotional stress, and that explanation remains surprisingly common. Severe physical or emotional stress may coincide with the onset or recurrence of alopecia areata in some susceptible individuals, but stress is not considered the underlying cause of the disease. In many patients, no specific triggering event can be identified.
Diagnosis and Treatment of Alopecia Areata
Diagnosis can often be made from the appearance and distribution of the hair loss and examination of the scalp and hair. Trichoscopy, which provides a magnified view of the scalp and follicles, may reveal characteristic findings such as yellow dots, black dots, broken hairs and tapered or exclamation point hairs. When the diagnosis remains uncertain, a scalp biopsy may sometimes be helpful.
Laboratory testing is not required for every patient but may be appropriate when thyroid disease, nutritional deficiency, hormonal abnormalities or another medical condition is suspected.
Treatment depends on the extent and duration of hair loss, the patient’s age, the areas involved, previous response to therapy, medical history and the emotional impact of the disease. The Severity of Alopecia Tool, commonly called the SALT score, is frequently used to estimate the percentage of scalp hair loss, although scalp percentage alone does not capture the full burden of the disease. Loss of eyebrows or eyelashes, rapid progression, chronic disease and psychosocial impact can also be clinically significant.
For limited patchy alopecia areata, spontaneous regrowth is possible and observation may sometimes be reasonable. Corticosteroids remain among the most established treatments. In adults with localized disease, corticosteroids may be injected directly into affected areas, while topical corticosteroids are commonly used in children and selected adults.
Minoxidil may sometimes be used as an additional treatment to support or maintain hair growth, but it does not address the underlying immune process responsible for alopecia areata.
For more extensive disease, treatment has historically included contact immunotherapy, systemic corticosteroids and other medications that suppress or modify immune activity. These approaches can still have a role in selected patients, but response varies and recurrence after successful regrowth remains possible.
There is no single treatment that works for everyone, and no current therapy can guarantee permanent remission. Treatment decisions should balance disease severity and activity, likelihood of meaningful regrowth, potential risks and the effect the disease is having on the individual patient.
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JAK Inhibitors and the Modern Treatment of Severe Alopecia Areata
The development of Janus kinase, or JAK, inhibitors has fundamentally changed the treatment landscape for severe alopecia areata. Research into the immune signaling pathways involved in the disease demonstrated that specific immune signals communicate through JAK pathways and help sustain the attack on the hair follicle. Blocking these pathways can interrupt that signaling and allow follicles to resume hair production in some patients.
As of 2026, three oral JAK inhibitors are FDA approved in the United States for severe alopecia areata. Baricitinib, marketed as Olumiant, is approved for adults. Ritlecitinib, marketed as Litfulo, is approved for adults and adolescents 12 years of age and older. Deuruxolitinib, marketed as Leqselvi, is approved for adults.
These approvals have provided important new treatment options for people with severe disease. Clinical trials have demonstrated substantial scalp hair regrowth in a meaningful proportion of patients, and some patients also experience regrowth of eyebrows and eyelashes.
Response varies considerably. Some patients experience dramatic regrowth, others achieve partial improvement and some do not respond adequately. JAK inhibitors are not a cure for alopecia areata. Ongoing treatment may be necessary to maintain regrowth, and hair loss can recur after therapy is discontinued.
These medications also carry important safety considerations. JAK inhibitors have FDA boxed warnings involving serious infections and other potentially significant risks, including malignancy, major cardiovascular events and thrombosis. Careful patient selection, review of medical history, appropriate laboratory evaluation and ongoing medical monitoring are important when these therapies are considered.
Research continues into additional targeted immune therapies and other approaches that may further expand treatment options. The progress made over the past several years is significant, but new treatments should still be judged by the quality of the evidence, durability of response, long term safety and their ability to improve outcomes that matter to patients.
For people living with severe alopecia areata, one of the most important changes is that physicians now have therapies developed around specific biological pathways involved in the disease rather than relying exclusively on broad immune suppression and older nonspecific treatments. Alopecia areata nevertheless remains an unpredictable disease, and treatment should be individualized according to age, disease severity, medical history, goals and tolerance for risk.
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