Alopecia Areata
What is Alopecia Areata?
Alopecia areata is a condition in which the hair on the scalp or body suddenly falls out, producing round or oval bald patches. It develops without warning and usually causes no noticeable symptoms such as itching.
In some cases the hair regrows on its own and the condition resolves within a few months; in others, the bald patches spread, increase in number, or persist over a long period. It can also recur after it has once cleared up.
Several other conditions can also cause hair loss, and because there is no way to predict whether alopecia areata will resolve on its own, we recommend that you see a doctor for a diagnosis and consider treatment as soon as you notice hair loss.
Types of Alopecia Areata
- Common type (patchy type)
- Single-patch type: only one bald patch
- Multiple-patch type: two or more bald patches
- Alopecia totalis: loss of all the hair on the scalp
- Alopecia universalis: loss of hair across the entire scalp as well as the eyebrows, eyelashes, beard, and body hair
- Ophiasis type: a band of hair loss along the hairline
- Sisaipho (reverse ophiasis) type: the hair on the sides and back of the head remains, while a band of hair loss occurs over the front and top of the scalp
- Diffuse type: no clearly defined bald patches, but an overall thinning of the hair
Causes of Alopecia Areata
It is thought to be an autoimmune disease. The hair follicles, which normally should not be attacked by the immune system, are invaded by lymphocytes and shrink, causing the hair to become thin and fall out.
Against a background of genetic predisposition, it is thought to be triggered by environmental factors such as fatigue, viral infections, vaccination, childbirth, and psychological or physical stress. Recently, cases believed to have been triggered by COVID-19 infection or its vaccine have been reported.
It is sometimes accompanied by other autoimmune conditions such as atopic dermatitis, Hashimoto’s disease, rheumatoid arthritis, and type 1 diabetes.
Treatment of Alopecia Areata
1. Topical steroids
A steroid ointment or cream is applied twice a day. Lotion formulations are not covered by insurance, and ointments and creams are not difficult to apply even on completely bald areas. This is an option for both single-patch and multiple-patch types and for patients of any age. Skin atrophy is the main side effect of concern.
2. Local steroid injection
Steroid injections are given into the affected areas. The recommended frequency is once every four to six weeks. It is suitable for single-patch and multiple-patch types but not for alopecia totalis. As a side effect, skin atrophy can occur, leaving a sunken depression. In the eyebrow area there are concerns about effects on intraocular pressure, so it is advisable to also consult an ophthalmologist. Because it is painful, it is not recommended for children. The injection sites bleed, so if you wish to cover them up, please bring a hat or similar.
3. Oral steroids
This may be used for adults in the early, rapidly progressing stage. It can lead to complete recovery, but a common problem is recurrence after the medication is stopped. Side effects to watch for include diabetes, osteoporosis, high blood pressure, impaired liver function, and glaucoma. It is a treatment that should be avoided in children.
4. Steroid pulse therapy
Steroids are administered by intravenous drip over about three days during a hospital stay. It carries the same side effects as oral steroids. It has been reported to work well in multiple-patch cases, cases with a limited area of hair loss, cases of recent onset, and cases in women, but here too its low safety profile and high recurrence rate are concerns. For those who wish to undergo it, we will refer you to a facility with inpatient care. It is a treatment that should be avoided in children.
5. Topical immunotherapy
This treatment involves applying strong irritant chemicals such as SADBE or DPCP to the skin to deliberately induce a contact reaction. If the reaction is strong, it can cause marked redness or blistering, fever with swollen lymph nodes, or pigmentation. It is not covered by insurance and is not currently offered at our clinic. For those who wish to undergo it, we will refer you to a facility that provides it.
6. Phototherapy (ultraviolet therapy)
This is recommended mainly for adults with the common type (single-patch or multiple-patch). Our clinic offers two types: narrow-band UVB (NB-UVB) and excimer light. We explain this in more detail on our phototherapy page.
7. Oral JAK inhibitors
As of October 2025, two insurance-covered medications are available: baricitinib (Olumiant®; Eli Lilly Japan), a selective JAK1/2 inhibitor in tablet form, and ritlecitinib (Litfulo®; Pfizer), a selective JAK3/TEC-family kinase inhibitor in capsule form. They are indicated for severe, treatment-resistant alopecia areata. They carry the side effect of immunosuppression, are expensive, and can recur once discontinued. They can only be administered at specific facilities. For patients considered eligible, we will refer you to an advanced medical institution as desired.