Alopecia areata is an autoimmune condition in which the immune system mistakenly attacks hair follicles, causing hair loss. Hair typically falls out in round or oval patches, most commonly on the scalp, though any hair-bearing area of the body can be affected, including the beard, eyebrows, eyelashes, and body hair.

The condition exists on a spectrum of severity.

Most people experience patchy hair loss (alopecia areata); in more severe forms, hair loss extends across the entire scalp (alopecia totalis) or the whole body (alopecia universalis).

Importantly, the hair follicles are not permanently destroyed – hair can regrow, sometimes spontaneously, though recurrence is common.

How common is Alopecia Areata?

Alopecia areata affects approximately 2% of the population over a lifetime, making it one of the most common autoimmune conditions. In Australia, it is estimated to affect around 500,000 people.

It can occur at any age – including in childhood – and affects men and women equally. People with a personal or family history of other autoimmune conditions, particularly thyroid disease, vitiligo, or type 1 diabetes, are at increased risk.

Common symptoms include:

• • Patchy hair loss – one or more smooth, round or oval bald patches, typically on the scalp but also in the beard, eyebrows, eyelashes, or body
  • Patches often appear suddenly, over days to weeks
  • Itching, burning, or tingling sensation may precede or accompany hair loss in some people
  • Nail changes – pitting, ridging, or brittleness of the nails occurs in some people with alopecia areata and can be a diagnostic clue
  • Exclamation mark hairs – short, tapered hairs at the edges of bald patches are a characteristic feature seen on examination
  • Diffuse or extensive hair thinning in more severe or longstanding disease

Alopecia areata does not typically cause pain and the underlying scalp appears normal (no scarring or inflammation visible on the surface).

Alopecia areata is an autoimmune condition in which T-lymphocytes target hair follicles.

The exact trigger is not fully understood, but contributing factors include:

• • Immune dysregulation – the JAK-STAT signalling pathway is a key driver of the autoimmune attack on hair follicles; this has led to the development of effective JAK inhibitor treatments
  • Genetics – multiple genetic variants are associated with alopecia areata, and it tends to run in families. Having a close relative with the condition increases risk
  • Other autoimmune conditions – an increased prevalence of thyroid autoimmunity, vitiligo, and atopic dermatitis in people with alopecia areata suggests shared immune pathways
  • Stress and illness – emotional stress or physical illness may trigger or worsen hair loss episodes, though they do not cause the condition

Alopecia areata is usually a clinical diagnosis made by a dermatologist based on the appearance and pattern of hair loss:

• • Examination – characteristic smooth, round bald patches; exclamation mark hairs at patch margins; nail pitting or ridging
  • Dermoscopy – a handheld magnifying device used to examine the scalp more closely; shows characteristic patterns of follicular changes
  • Blood tests – thyroid function and autoantibody testing to screen for associated conditions; full blood count
  • Scalp biopsy – rarely needed for straightforward presentations; may be used to confirm the diagnosis in atypical cases or exclude other causes of hair loss (e.g. scarring alopecia, tinea capitis)

A trichologist or dermatologist with hair loss expertise should be consulted for assessment and management of moderate to severe disease.

Treatment depends on the extent of hair loss, the patient's age, and the impact on quality of life. Mild patchy disease may resolve spontaneously without treatment; moderate to severe disease warrants active therapy.

• • Topical and intralesional corticosteroids — For limited patchy disease, topical corticosteroids or intralesional corticosteroid injections into affected areas are often the first treatment used. They suppress local immune activity and can stimulate hair regrowth.
  • JAK inhibitors (targeted oral therapy) — JAK inhibitors (Janus kinase inhibitors) work by interrupting the signalling pathway that drives the autoimmune attack on hair follicles. Baricitinib (Olumiant) and ritlecitinib (Litfulo) are options for adults with severe alopecia areata and represent the first systemic treatments specifically approved for this condition.
  • Other systemic immunosuppressants — Ciclosporin, methotrexate, and oral corticosteroids have historically been used for severe or extensive disease, with variable response and significant side effects limiting long-term use.
  • Minoxidil — Topical or oral minoxidil is sometimes used to support hair regrowth but does not address the underlying autoimmune process.

The following specialty medications are available at Ace, a specialty pharmacy for Alopecia Areata.

With Ace, you’ll benefit from:

• • Expert Support — Our dedicated team of health concierges is always available to answer your questions, provide guidance, and help you navigate your condition with confidence.
  • Specialty Medication — We offer a wide range of specialty medications and support services, designed specifically for those living with chronic illnesses. Whether you’re looking for help managing a specific condition, or simply need access to the medications you need, we’ve got you covered.
  • A Wide Range of Conditions — From diabetes to heart disease, and everything in between, we help manage a variety of special condition

Take control of your health and well-being, and start your journey to better health with Ace today.

Alopecia Areata Support

• • Alopecia Australia – Australia's peak support organisation for people living with alopecia areata; peer support, events, and information
  • Australasian College of Dermatologists – Find a Dermatologist

Clinical Resources

• • Healthdirect – Alopecia Areata
  • DermNet – Alopecia Areata – comprehensive clinical dermatology resource
  • ASCIA – Alopecia Areata