Alopecia Areata (Hair Loss): Symptoms and Treatment

What is Alopecia Areata (Hair Loss)?

Alopecia areata is a non-scarring inflammatory hair disease in which the immune system targets the hair follicle.

It is most often noticed as sudden, round or oval areas of hairlessness on the scalp. However, it can affect not only the scalp but also the beard, eyebrows, eyelashes, and other body hair.

The course of the disease varies considerably from person to person. While some patients may experience spontaneous improvement in small, limited areas, others may develop new areas or more widespread hair loss.

Briefly, what you need to know

Ringworm is not contagious.

It is not a fungal infection.

It does not occur because of anything the patient did.

It is an immune system-related disease.

Hair follicles typically do not disappear permanently.

Hair may regrow spontaneously; however, the course of the disease is unpredictable.

Eyebrows, eyelashes, beard, and nails can also be affected.

Today, there are targeted systemic treatment options for widespread and severe alopecia areata that were not available in the past. (OUP Academic)

What does alopecia areata look like?

The classic appearance is characterized by smooth, round or oval areas of hairlessness on the scalp.

At the edges of active disease, some hairs may appear thinner towards the roots. These are classically referred to as exclamation-mark hairs.

During trichoscopy, black spots, broken hairs, and other characteristic findings may be observed.

However, alopecia areata does not always appear as a single, circular area.

What are alopecia totalis and alopecia universalis?

The disease can manifest differently depending on its severity.

Alopecia areata: Limited or numerous areas of hair loss.

Alopecia totalis: Hair loss affecting all or almost all of the hair on the scalp.

Alopecia universalis: Widespread hair loss on the face and body, along with scalp hair.

Rather than considering these as entirely separate diseases, it is more accurate to view them as different manifestations of alopecia areata. (OUP Academic)

What is ophthalmia?

In some patients, hair loss may progress in a band-like pattern, particularly along the nape and temporal regions. This pattern is called ophiasis.

Such clinical patterns can be important for dermatologists in understanding the course of the disease and planning treatment; however, the patient does not need to self-identify the subtype.

What causes alopecia areata?

Alopecia areata is an autoimmune disease.

The immune system disrupts the hair follicle's normal growth cycle, leading to hair loss.

Genetic predisposition is also thought to play an important role.

However:

“"Alopecia areata is caused by stress."”

The common explanation, "this is too simplistic," is far from straightforward.

Stress may be associated with the onset or exacerbation of the disease in some patients; however, it is not the sole cause of alopecia areata.

Is ringworm contagious?

No.

Alopecia areata is not a bacterial, fungal, or viral infection. It is not transmitted to another person through using the same comb or towel, touching, or close contact.

This distinction is especially important in children because tinea capitis (scalp fungus) can sometimes cause hair loss and is contagious.

The two diseases are different.

Is it associated with other autoimmune diseases?

Individuals with alopecia areata may have a higher than average risk of developing other autoimmune diseases.

It can be seen particularly in association with thyroid diseases, vitiligo, and some other autoimmune conditions.

However, this:

“"Everyone with alopecia areata should undergo a comprehensive autoimmune panel."”

That doesn't mean anything.

The current BAD guidelines recommend that routine blood tests are not necessary for most patients, and that investigations should be based on the patient's history and clinical findings. (OUP Academic)

This is an important message for our site.

Can it affect the nails?

Yes.

In alopecia areata, small pits, surface changes, or other nail abnormalities may be observed in the nails.

Therefore, during a dermatological examination, not only the scalp but also the nails, eyebrows, and eyelashes are examined when necessary.

How is alopecia areata diagnosed?

In most patients, the diagnosis can be made through history and dermatological examination.

Trichoscopy can support the diagnosis and provide information regarding disease activity.

The 2025 BAD guidelines recommend using the SALT (Severity of Alopecia Tool) score to monitor the extent of the disease. SALT helps to standardize the percentage of hair loss on the scalp. (OUP Academic)

In selected cases where the diagnosis is uncertain, a biopsy or other investigations may be necessary.

Do all patients with alopecia areata need blood tests?

No.

We will protect this area especially.

BAD's most current Living Guideline clearly states:

Diagnostic tests should be selected based on the patient's history and clinical presentation; routine blood tests are unnecessary in most patients. (OUP Academic)

For example, if there is a history or clinical findings suggestive of thyroid disease, investigations may be carried out accordingly.

However, automatically assigning a 25-parameter "hair loss panel" to a patient is not a scientific approach.

How is ringworm treated?

Treatment selection should be based solely on:

“"How many openings are there?"”

The question is not considered.

We will consider the following together:

Factors affecting quality of life include: disease prevalence + how quickly it progresses + patient's age + eyebrow/eyelash involvement + previous treatments + disease duration + impact on quality of life.

Güncel BAD sınıflamasında saçlı deri kaybı kabaca %1–20 sınırlı, %21–49 orta ve %50–100 şiddetli olarak değerlendiriliyor; ancak kaş/kirpik tutulumu, hızlı progresyon gibi ek özellikler hastalığın klinik önemini artırabiliyor. (OUP Academic)

Corticosteroid treatments

Corticosteroids have long been among the primary treatments for limited alopecia areata.

Topical or intralesional corticosteroid injections may be used in suitable patients.

However, the application area, the patient's age, and the extent of the disease will alter the choice of treatment.

Contact immunotherapy

In more widespread disease, contact immunotherapy methods such as DPCP (diphenylcyclopropenone) can be used in selected patients.

But we won't simplify this from the patient's perspective by calling it "ringworm medication"; these are dermatological treatments requiring special application and follow-up. (OUP Academic)

Have JAK inhibitors changed the treatment of alopecia areata?

Yes.

This is one of the most scientifically up-to-date sections of the page.

With a better understanding of the immune mechanisms of alopecia areata, Janus kinase (JAK) inhibitors have become important targeted therapeutic options, especially in severe disease.

The current BAD Living Guideline considers JAK inhibitors as systemic treatment options, and the 2025 update incorporates new clinical evidence into treatment recommendations. (OUP Academic)

Because this area is changing rapidly, we will explain licensing and access status by country on the site without confusing them.

The main message from the patient's perspective is this:

In widespread alopecia areata, there is no longer a treatment system consisting solely of cortisone and older immunosuppressive therapies.

However, JAK inhibitors are not simply “hair-growing drugs.” Appropriate patient selection and monitoring are necessary due to infections, laboratory changes, and other drug-specific safety concerns.

Does minoxidil treat ringworm?

Minoxidil may be considered as an adjunct therapy in some patients, but it is not the primary treatment targeting the underlying autoimmune mechanism of alopecia areata.

Therefore, we will not confuse its role in androgenetic alopecia with its role in alopecia areata.

Is platelet-rich plasma (PRP) a treatment for alopecia areata?

Studies on PRP exist; however, presenting it as a primary treatment with the same level of evidence as corticosteroids, contact immunotherapy, and targeted systemic therapies in appropriately severe cases within the current treatment algorithm for high-level alopecia areata is not accurate.

Therefore, we will not change the scientific hierarchy just because we have equipment or injection services in our clinic.

Will the hair grow back?

It can come out.

Spontaneous hair regrowth can occur, especially in limited cases of the disease.

However, the course of the disease is unpredictable. Hair loss may recur in another area after regrowth, or the disease may become more widespread.

Because:

“"It will definitely come out."”

or

“"Once it appeared, it's completely gone."”

That is not correct.

The BAD guidelines also specifically recommend explaining to the patient that treatments may not always be effective and that expectations should be managed realistically. (OUP Academic)

Is alopecia areata psychologically significant?

Yes, and we're not going to dismiss this as a "cosmetic problem.".

Widespread hair loss, especially eyebrow and eyelash loss, can seriously affect a person's social life and psychological well-being.

BAD’s 2025 guidelines strongly recommend the active assessment of quality of life and psychological distress. (OUP Academic)

Therefore, it is not accurate to measure the severity of the disease solely by the centimeter area of hairless skin.

When should you consult a dermatologist?

Dermatological evaluation is appropriate, especially if sudden, round bald patches appear on the scalp, if the patches are growing rapidly, if new areas are being added, if the eyebrows or eyelashes are affected, if hair loss is widespread, or if the diagnosis is uncertain.

Rapidly progressing or widespread alopecia areata is specifically listed in the current BAD guidelines as a condition requiring expert evaluation. (OUP Academic)

Frequently Asked Questions

Is alopecia areata caused by a fungal infection? No. Alopecia areata is an autoimmune disease.

Is ringworm contagious? No.

Does stress cause alopecia? Stress can be a trigger in some people, but it is not the sole cause of the disease.

Do hair follicles die in alopecia areata? Alopecia areata is a type of alopecia that does not leave scars; the follicles typically do not permanently disappear. Therefore, hair regrowth is possible.

Can alopecia areata recur? Yes. The disease can recur, and its course varies from person to person.

Is it necessary to use vitamins for alopecia areata? If there is an identified deficiency, it needs to be corrected; however, vitamin therapy is not the standard treatment for the autoimmune mechanism of alopecia areata.

Can JAK inhibitors be used for alopecia areata? JAK inhibitors are among the current systemic treatment options for suitable moderate-to-severe/severe patients. Which patient is suitable depends on age, disease severity, health status, and the safety profile of the drug. (OUP Academic)