Alopecia areata is an autoimmune condition in which the body’s immune system attacks its own hair follicles, causing patchy hair loss that can range from a single small patch to complete scalp hair loss (alopecia totalis) or complete body hair loss (alopecia universalis). Understanding what the condition is — and is not — is the starting point for managing it effectively.
The hair loss in alopecia areata typically presents as well-defined, smooth, round or oval patches on the scalp, without scaling or inflammation visible on the skin surface. The follicles are not destroyed — they are suppressed by the autoimmune attack. This is why spontaneous regrowth occurs in many patients, and why treating the underlying autoimmune response can restore hair.
Spontaneous remission occurs in approximately 50% of patients with limited patch alopecia within twelve months, without treatment. The remaining patients either stabilise with limited loss or progress to more extensive or total alopecia. Predicting which course will occur is currently not possible at the individual patient level.
The treatment landscape for alopecia areata has changed significantly with the approval of JAK inhibitors — particularly baricitinib and ritlecitinib — for moderate to severe alopecia areata. These are the first medications approved specifically for this indication that have shown meaningful, consistent hair regrowth in clinical trials. They represent a genuine advance beyond the corticosteroids, immunotherapy, and other treatments that have been used for decades with limited evidence.
Hair transplant surgery is generally not appropriate for active alopecia areata. The autoimmune attack will affect transplanted follicles in the same way it affected native ones. In patients with long-term stable remission, surgical restoration may be considered — but only after a detailed dermatological assessment.
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