Definition
What is Alopecia areata?
Alopecia areata is an autoimmune condition in which hair follicles are targeted by the immune system. Normally the hair follicle is a protected zone that immune cells don't «see». In alopecia areata this protection breaks down; immune cells gather around the follicle and push it out of the growth phase too early, causing the hair to fall out. The key point: the follicle's stem cells are usually not damaged. That's why, in alopecia areata, hair can often grow back.
The typical look is one or a few coin-sized, round or oval, smooth bald patches on the scalp or in the beard. The skin is usually a normal color; there's no scaling, wound or obvious redness. At the edges you may see short, broken hairs that taper toward the base and look like an «exclamation mark». In men, beard involvement is common, and a newly appearing gap in the beard is often the first thing noticed. More rarely, the whole scalp (alopecia totalis) or all body hair (alopecia universalis) can be lost.
The course varies a lot from person to person. In many men, alopecia areata that starts as a single small patch clears up on its own within a few months; in others, new patches appear or it comes back over the years. Regrowing hairs may be white or fine at first and return to their original color over time. Alopecia areata isn't contagious, has nothing to do with personal hygiene and definitely doesn't happen «because you did something». In recent years, new treatments targeting immune pathways have opened up promising options, especially for widespread and stubborn cases.
Check yourself
How do you spot it?
- ✓Round or oval bald patches with sharp borders on the scalp or in the beard
- ✓Smooth, normal-colored, unbroken skin in the bald patch
- ✓Short, broken hairs at the edges that taper toward the base
- ✓A sudden, clean-edged gap appearing in the beard
- ✓In some people, mild tingling or itching before a bald patch appears
- ✓Patchy loss in the eyebrows, eyelashes or body hair
- ✓Small pits or roughness in the nails
- ✓Regrowing hairs that are white and fine at first
Why it happens
Main causes
01
An autoimmune process
At the root of alopecia areata is the immune system targeting hair follicles. In particular, certain immune cells and their signaling pathways interrupt the follicle's growth phase.
02
Genetic predisposition
The risk is higher in people with a family history of alopecia areata or other autoimmune diseases. Genetic studies show that many immune-related gene regions play a role in this predisposition.
03
Accompanying autoimmune and allergic conditions
Conditions such as thyroid disease, vitiligo, atopic dermatitis and asthma may be more common in people with alopecia areata. That's why your dermatologist may order certain tests, such as thyroid tests, if needed.
04
Stress and major life events
Many men say they noticed their first bald patch after a period of intense stress, grief, military service, job loss or a serious illness. Stress isn't a cause on its own; but it's thought it may act as a trigger in predisposed people.
05
Infections and environmental factors
Past viral infections, certain medications and environmental factors are also among the things that may trigger alopecia areata by changing immune balance.
In daily life
Triggers that cause flare-ups
Medical approach
Treatment options
01
Watch and wait
For alopecia areata limited to a single small patch, your dermatologist may recommend just monitoring it, since many cases clear up on their own within a few months. This doesn't mean «doing nothing» but regularly checking whether the patch is growing.
02
Local anti-inflammatory treatments
Corticosteroid lotions and creams applied to the bald patch, or injections your dermatologist gives into the patch, can help calm the immune response locally. In areas like the beard, how often and how they're applied is decided by your doctor.
03
Contact immunotherapy and other options
For widespread alopecia areata, contact immunotherapy may be used; it aims to draw the immune system's attention away from the follicle by creating a controlled allergic reaction on the scalp. Topical solutions that support hair growth can also be added to treatment.
04
JAK inhibitors
In severe, widespread alopecia areata, a group of drugs called JAK inhibitors, which suppress immune signaling inside the cell, led to significant hair and beard regrowth in large clinical trials. These drugs are used only by a specialist, with regular blood test monitoring and an assessment of side effects.
05
Psychological support
Alopecia areata, especially in the beard and face area, can deeply affect a man's self-confidence. Getting professional support to manage anxiety and stress can help you carry the treatment process more easily.
Did you know? · Alopecia areata
2% · According to a meta-analysis pooling 94 studies, alopecia areata affects about 2% of the world's population, and its frequency has risen over the years.
Step by step
Care routine for Alopecia areata
3 steps
- 01
Gentle cleansing
Wash your scalp and beard with lukewarm water and a gentle, fragrance-free cleanser. Clean the bald patch with your fingertips without rubbing.
- 02
Your doctor's local product
If your dermatologist recommended a lotion or solution, apply it in the prescribed amount and only to the specified area. Don't spread the product to surrounding areas on your own.
- 03
Sun protection
Bald patches burn easily in the sun. Wear a hat for patches on the scalp, and use a facial sunscreen for patches on the face and beard.
Caution
What to avoid, and when to see a doctor?
Avoid these
- ✕Rubbing the bald patch with garlic, onion, lemon or alcohol
- ✕Constantly picking at the bald patch or pulling hairs
- ✕Products with unclear ingredients that promise a «guaranteed cure» for alopecia areata
- ✕Getting medications or injections online without consulting a doctor
- ✕Using thick, irritating dyes to cover up a gap in your beard
- ✕Completely neglecting sleep and nutrition during stressful periods
See a dermatologist
- →If you've noticed a round, bald patch in your hair or beard
- →If bald patches grow or multiply within a few weeks
- →If you're also losing hair in your eyebrows, eyelashes or body hair
- →If you've noticed pits or changes in the shape of your nails
- →If the bald patch has redness, scaling, sores or inflammation (it may point to another condition)
- →If you have thyroid disease or another autoimmune disease
- →If you're experiencing anxiety or avoiding social situations because of alopecia areata
Common misconceptions
Myth or fact?
✕Common belief
Alopecia areata is contagious and you can catch it at the barber.
✓Fact
Alopecia areata is an autoimmune condition; it isn't caused by germs and doesn't spread at the barber or through shared items. If a bald patch has scaling, sores and inflammation, it may be a different condition and needs a dermatologist's assessment.
✕Common belief
If you shave the bald patch, the hair grows back thicker.
✓Fact
Shaving doesn't change the number or thickness of hair follicles. Regrowth in alopecia areata depends on the immune response calming down.
✕Common belief
Alopecia areata is caused only by stress.
✓Fact
Stress can be a trigger in some people, but the underlying cause is an autoimmune process working together with genetic predisposition. Alopecia areata can also appear in men who feel they've had no stress at all.
Popular searches
Most asked about Alopecia areata
Your questions
Frequently asked questions
01Does alopecia areata go away on its own?+
When alopecia areata is limited to a single small patch, hair grows back on its own in many men within a few months to a year. But because new patches can appear or it can come back, it's wise to see a dermatologist and have the process monitored.
02What causes alopecia areata in the beard?+
Alopecia areata in the beard is the same autoimmune process as on the scalp; the immune system targets the beard follicles. In men, the first sign is often a round, smooth gap that appears in the beard. Because the follicles usually stay alive, the beard can grow back.
03Does alopecia areata come back?+
Yes, in some people alopecia areata can recur over the years. Starting at a young age, widespread involvement, nail changes and a family history may be linked to a higher chance of recurrence and a longer course. Early assessment with each new episode widens your options.
04Why are regrowing hairs white?+
Because the immune response can also affect pigment cells, regrowing hairs may be white or light-colored at first. This is usually temporary, and the hair's color returns over time.
05Can alopecia areata turn into complete baldness?+
In most men, alopecia areata stays limited to one or a few patches. Types in which the whole scalp or all body hair is lost are rare. For widespread, stubborn cases, treatments developed in recent years offer important options.
06What kind of doctor should I see for alopecia areata?+
For alopecia areata you should see a dermatologist (skin specialist). Your dermatologist makes the diagnosis, orders tests such as thyroid tests if needed and sets up a monitoring or treatment plan based on the size of the bald patch.
Scientific basis
Sources
- 01Epidemiology of alopecia areata, ophiasis, totalis, and universalis: A systematic review and meta-analysis
Lee HH, Gwillim E, Patel KR, Hua T, Rastogi S, Ibler E, Silverberg JI · Journal of the American Academy of Dermatology · 2020 · doi:10.1016/j.jaad.2019.08.032
A meta-analysis of 94 studies found that alopecia areata affects about 2% of the world's population and that its frequency has increased over time.
- 02Alopecia areata
Pratt CH, King LE Jr, Messenger AG, Christiano AM, Sundberg JP · Nature Reviews Disease Primers · 2017 · doi:10.1038/nrdp.2017.11
Summarized alopecia areata as an autoimmune disease that develops when the hair follicle's immune protection breaks down, usually sparing the stem cells, which is why hair can grow back.
- 03Alopecia areata: Disease characteristics, clinical evaluation, and new perspectives on pathogenesis
Strazzulla LC, Wang EHC, Avila L, Lo Sicco K, Brinster N, Christiano AM, Shapiro J · Journal of the American Academy of Dermatology · 2018 · doi:10.1016/j.jaad.2017.04.1141
Described in detail the clinical types of alopecia areata, signs such as exclamation-mark hairs and nail changes, and accompanying conditions.
- 04Alopecia areata: A multifactorial autoimmune condition
Simakou T, Butcher JP, Reid S, Henriquez FL · Journal of Autoimmunity · 2019 · doi:10.1016/j.jaut.2018.12.001
Reviewed alopecia areata as a multifactorial autoimmune condition in which genetics, immunity, environmental factors and the microbiome all play a role.
- 05Scalp bacterial shift in Alopecia areata
Pinto D, Sorbellini E, Marzani B, Rucco M, Giuliani G, Rinaldi F · PLoS One · 2019 · doi:10.1371/journal.pone.0215206
Showed for the first time that the bacterial community on scalps with alopecia areata differs from that on healthy scalps.
- 06Association Between Scalp Microbiota Imbalance, Disease Severity, and Systemic Inflammatory Markers in Alopecia Areata
Gómez-Arias PJ, Gay-Mimbrera J, Rivera-Ruiz I, Aguilar-Luque M, Juan-Cencerrado M, Mochón-Jiménez C, Gómez-García F, Sánchez-González S, Ortega-Hernández A, Gómez-Garre D, Parra-Peralbo E, Isla-Tejera B, Ruano J · Dermatology and Therapy · 2024 · doi:10.1007/s13555-024-01281-2
Reported that scalp microbiota imbalance is linked to disease severity and inflammatory markers in the blood, though the cause-and-effect relationship isn't yet clear.
- 07Safety of Baricitinib in Adults with Severe Alopecia Areata from Two Phase III Trials Over a Median of 2.3 Years and Up to 4 Years of Treatment
King B, Mostaghimi A, Shimomura Y, Piraccini BM, Blume-Peytavi U, Sontag A, Dutronc Y, Denning K, Kolodsick J, Lu X, Srivastava A, Sinclair R · American Journal of Clinical Dermatology · 2025 · doi:10.1007/s40257-025-00932-0
Evaluated safety data for a JAK inhibitor used for up to four years in severe alopecia areata across two large phase 3 trials.
- 08The BEARD Score: A Practical Tool to Assess Beard Involvement in Alopecia Areata
Gallo G, Sciamarrelli N, Ribero S, Mastorino L, Quaglino P, Rosset F · International Journal of Dermatology · 2026 · doi:10.1111/ijd.70282
Proposed a practical scoring tool for assessing beard involvement in alopecia areata in a standardized way.
- 09Alopecia areata
American Academy of Dermatology · American Academy of Dermatology Association · 2024
Explained that alopecia areata isn't contagious, can affect the beard, eyebrows and eyelashes as well as the scalp, and that hair often grows back.
