Alopecia areata most commonly presents as smooth, well-defined patches of hair loss on the scalp. The skin in affected areas usually looks normal, without significant scaling or scarring. Symptoms and findings may include:

• Round or oval patches of hair loss on the scalp
• Hair loss of the beard (often in patchy areas)
• Thinning or loss of eyebrows and eyelashes in some cases
• Short, broken hairs at the edges of patches (sometimes described as “exclamation point” hairs)
• Nail changes such as pitting, ridging, or brittleness in a subset of patients
• More extensive patterns such as alopecia totalis (complete scalp hair loss) or alopecia universalis (loss of scalp and body hair)

Symptoms can also include scalp sensitivity or mild itching, but many individuals have no discomfort. The emotional impact can be significant, especially when hair loss is sudden or affects visible areas such as the frontal scalp, eyebrows, or beard.

Alopecia areata is considered an immune-mediated condition in which the immune system targets hair follicles, interrupting the normal hair growth cycle. Hair follicles remain alive, which is why regrowth is possible in many cases. Contributing factors can include:

• Genetic predisposition, as alopecia areata can occur in families
• Immune system dysregulation, which triggers follicle inflammation
• Associations with other conditions, including thyroid disease and atopic conditions in some individuals
• Stress or illness, which may coincide with onset or flares for some patients

Alopecia areata is not contagious and is not caused by hair products, routine washing habits, or poor hygiene.

Diagnosis typically begins with a focused history and physical examination. Dr. Thomas Knackstedt and the Peak Skin Center team evaluate the pattern of hair loss, the timeline of onset, and any history of recurrence. The assessment may include:

• Examination of the scalp, eyebrows, beard area, and body hair
• Evaluation for nail findings that may support the diagnosis
• Use of dermoscopy (a magnified skin and scalp exam) to identify characteristic hair patterns
• Review of medical history for autoimmune or inflammatory conditions
• Consideration of laboratory testing in select cases, particularly when symptoms suggest an associated condition such as thyroid disease
• A scalp biopsy in uncommon situations when scarring alopecia, fungal infection, or another diagnosis needs to be ruled out

Accurate diagnosis is important because several conditions can mimic alopecia areata, and treatment selection depends on identifying the correct cause of hair loss.

Treatment depends on the extent of hair loss, duration, age, and prior response to therapy. Some cases improve without treatment, while others benefit from early intervention to support regrowth and reduce progression.

Common medical treatment options include:

• Intralesional corticosteroid injections: Frequently used for limited patchy alopecia areata on the scalp or beard to reduce inflammation around follicles and encourage regrowth.
• Topical corticosteroids: Often used for milder disease, for children, or as adjunct therapy when injections are not appropriate.
• Oral or systemic therapies: In more extensive or rapidly progressive disease, systemic anti-inflammatory approaches may be considered based on severity, health history, and risk profile.
• JAK inhibitor medications for severe alopecia areata: In appropriate candidates, FDA-approved JAK inhibitors can be considered for severe disease. Options include medications approved for adults and, for certain agents, adolescents. These treatments require medical supervision and appropriate monitoring.

Supportive measures may also be included:

• Guidance on gentle scalp care and camouflage strategies
• Counseling regarding triggers, recurrence patterns, and expectations for timelines
• Evaluation of eyebrow and eyelash options when cosmetically significant loss occurs

Alopecia areata often requires follow-up to assess response, adjust therapy, and maintain regrowth when possible.