An autoimmune condition affecting around 2% of the UK population. Patches can be temporary or progress to total loss — specialist assessment is essential before considering any treatment.
Alopecia areata is an autoimmune condition in which the body's immune system mistakenly attacks its own hair follicles, causing them to stop producing hair. It typically presents as one or more smooth, circular patches of hair loss on the scalp, though it can affect eyebrows, eyelashes and body hair.
Unlike androgenetic alopecia, alopecia areata does not destroy the follicle — the follicle remains alive but dormant. This means spontaneous regrowth is possible, and often occurs, particularly in mild cases.
The course of the condition is highly unpredictable. Some patients experience a single episode and never relapse. Others have a chronic, relapsing pattern. A minority progress to alopecia totalis (total scalp loss) or alopecia universalis (total body hair loss).
The exact trigger is unknown, though genetic predisposition and stress appear to play a role. It is not contagious and is not caused by diet, styling products or hygiene.
No treatment currently offers a permanent cure for alopecia areata. The goal is to suppress the autoimmune response, encourage regrowth, and manage the psychological impact of the condition.
Intralesional steroid injections (triamcinolone) are the most common first-line treatment for patchy alopecia areata. Delivered directly into the patch every 4–6 weeks. Effective in around 60–70% of suitable cases.
Diphencyprone (DPCP) applied weekly to sensitise the immune system and redirect the autoimmune attack. Used for extensive alopecia totalis. Available at specialist dermatology centres.
Baricitinib (Olumiant) — approved by NICE in 2023 for severe alopecia areata. Oral JAK inhibitor that blocks inflammatory signals. Significant regrowth in trials. Requires specialist prescription.
Topical minoxidil may support regrowth in alopecia areata by prolonging the growth phase and improving blood supply to follicles. Often used alongside corticosteroids. Does not treat the underlying autoimmune process.
FUE is an option for alopecia areata only when the condition has been stable for at least 2 years with no new patches and adequate donor density. Transplanting into an active autoimmune process risks losing the transplanted grafts. DrQ assesses each case individually.
Alopecia areata has a significant psychological impact. Cognitive behavioural therapy (CBT), support groups (Alopecia UK) and counselling are important components of management — often underutilised.
FUE hair transplantation can produce excellent results in alopecia areata — but only under the right circumstances. The key criteria are:
Important: Transplanting into an active alopecia areata process risks losing the transplanted grafts. An honest assessment of disease stability is non-negotiable before proceeding. DrQ will tell you clearly if surgery is not in your best interest.
In mild to moderate cases, spontaneous regrowth is common — around 50% of patients with limited alopecia areata see regrowth within 12 months without treatment. However, the condition is unpredictable and relapse is possible even after full regrowth.
Stress is commonly cited as a trigger for alopecia areata episodes, and there is evidence that psychological stress can dysregulate the immune system. However, alopecia areata is primarily an autoimmune condition with genetic components — stress alone does not cause it.
There is a genetic component to alopecia areata. Approximately 20% of people with the condition have a family member affected. It is associated with other autoimmune conditions including thyroid disease and vitiligo.
Only if the condition has been stable for at least 2 years with no new patches and an adequate donor zone. Transplanting into an active autoimmune process is not appropriate — the grafts risk being rejected. DrQ provides an honest assessment of suitability.
Pattern baldness (androgenetic alopecia) is driven by DHT-induced follicle miniaturisation — it follows a predictable, gradual pattern and is not autoimmune. Alopecia areata is an autoimmune attack on follicles that causes sudden, patchy loss with no pattern — and the follicle is not destroyed, so regrowth is possible.
DrQ will review your photos and history personally and give you a straight answer about whether treatment — medical or surgical — is appropriate for your case.
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