Alopecia Areata: Causes, Chance of Regrowth and Evidence-Based Treatment

Short answer: Alopecia areata is an autoimmune disease in which the immune system temporarily attacks the hair follicle. It is not contagious, the follicle is not destroyed, and more than half of limited patches regrow within a year. For extensive disease there are now licensed systemic options that require specialist follow-up.

Signs

• Round or oval, smooth, sharply defined bald patches without scaling

• Short broken "exclamation-mark" hairs at the edge of an active patch

• Beard, eyebrow or eyelash involvement

• Pitted nails in a proportion of patients

• Rarely, loss of all scalp hair (totalis) or all body hair (universalis)

Diagnosis

Trichoscopy usually confirms the diagnosis without a biopsy: yellow dots, black dots, exclamation-mark and short vellus hairs. Scalp ringworm in children, trichotillomania and scarring alopecias must be excluded. Thyroid function and antibodies are checked because autoimmune thyroid disease is more common.

Treatment

• Limited patches: intralesional corticosteroid injections every 4-6 weeks; potent topical steroids in children; topical minoxidil as support.

• Extensive or refractory disease: JAK inhibitors (baricitinib, ritlecitinib, deuruxolitinib) are licensed for severe alopecia areata. They are continuous treatments with relapse on stopping and require blood monitoring.

• Contact immunotherapy (DPCP) remains an option where JAK inhibitors are unsuitable.

• PRP and mesotherapy have weak, inconsistent evidence in alopecia areata and are not standard treatment.

Prognosis

Onset in childhood, ophiasis pattern, nail involvement, atopy and extensive loss predict a longer, relapsing course. Relapse does not mean the treatment failed; it is the nature of the disease.

Patients from Bulgaria and Greece

Our practice is in Kırklareli, a short drive from the Bulgarian and Greek borders. Consultation, trichoscopy and the first treatment are usually completed in a single visit; follow-up runs by photo and WhatsApp. See our hair loss treatments page for the overall approach.

Appointments: +90 555 209 09 39 (WhatsApp) · info@drkagancingoz.com · İstasyon Mah. Edirne Cad. No:102, Kırklareli, Türkiye

Related articles

More from the hair series: Hair loss treatments · Androgenetic alopecia · Telogen effluvium · Scarring alopecias · Scalp diseases · Trichoscopy and hair analysis · Hair PRP · Hair mesotherapy