Health condition · Clinically reviewed
Alopecia areata, autoimmune patchy hair loss — with new oral JAK inhibitors.
A treatable autoimmune cause of patchy hair loss. Topical and intralesional steroids remain foundational; new oral JAK inhibitors (baricitinib, ritlecitinib) have transformed severe disease.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Checked against BAD, Alopecia UK and peer-reviewed sources you can see at the end.
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Current for 2026
Reflects modern UK practice including oral JAK inhibitors (baricitinib, ritlecitinib) for severe disease.
Key facts
Alopecia areata at a glance.
The essentials, in plain English — what it is, how it can progress, how severity is measured, and how it’s treated in the UK today.
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What it is
An autoimmune, non-scarring form of hair loss where the immune system attacks hair follicles — hair can and often does regrow.
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How it can progress
Patchy loss → alopecia totalis (all scalp hair) → alopecia universalis (whole body). Most people stay in the patchy form.
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Measuring severity
Dermatologists use the SALT score (Severity of Alopecia Tool) to grade scalp involvement and track response.
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Who is at higher risk
People with atopy (eczema, hay fever, asthma) and autoimmune thyroid disease have a higher background risk.
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New oral options
Baricitinib and ritlecitinib — oral JAK inhibitors — are now licensed for severe alopecia areata.
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Mind and mood
The psychological impact is significant and deserves the same attention as the skin — support is part of good care.
Why this guide matters
A treatable disease, and a very changed toolkit.
Alopecia areata is autoimmune and non-scarring — hair can regrow. The three points below shape everything else on this page.
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Hair can regrow
Follicles are not destroyed — regrowth is possible, and often happens with the right treatment.
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Severity guides treatment
Limited disease responds to topical or intralesional steroids; severe disease needs a specialist ladder.
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Oral JAK inhibitors have changed care
Baricitinib and ritlecitinib have transformed outcomes in severe alopecia areata — ask about them.
How the diagnosis is made
From first patch to a clear plan.
The steps a UK GP or dermatologist will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
Pattern, trichoscopy and mimics
Phase 2 · Confirming
Bloods, SALT and quality of life
Phase 3 · Managing
Referral and treatment ladder
- 01
Recognising
Skin and hair examination
A clinician looks at the pattern of hair loss, examines the scalp, and checks eyebrows, eyelashes and body hair.
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Recognising
Trichoscopy
A dermatoscope reveals classic features — exclamation-mark hairs, yellow dots and short broken hairs.
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Recognising
Rule out tinea capitis
Especially in children — a fungal scalp infection can mimic alopecia areata and needs different treatment.
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Confirming
Autoimmune screen
Thyroid function and coeliac serology are commonly checked given the autoimmune overlap.
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Confirming
SALT score
Severity of Alopecia Tool — grades the percentage of scalp involvement and guides treatment choice.
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Confirming
DLQI
Dermatology Life Quality Index — captures the day-to-day impact on wellbeing, work and relationships.
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Managing
Dermatology referral
For extensive or rapidly progressive disease — for intralesional treatment, immunotherapy or an oral JAK inhibitor.
Typical timeline: a first visit to a settled plan in weeks, not months.
Symptoms
What alopecia areata actually looks like.
The classic pattern of well-defined patchy loss — plus the features that signal a more extensive form and prompt escalation.
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Patchy round hair loss
Well-defined, smooth, coin-shaped bald patches — usually on the scalp, sometimes elsewhere.
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Nail changes (pitting)
Fine pitting, ridging or roughening of the nails — a supportive clue to the diagnosis.
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Alopecia totalis
Complete loss of all scalp hair — a more severe, less common form.
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Alopecia universalis
Loss of scalp, eyebrow, eyelash and body hair — the most extensive form.
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Exclamation-mark hairs
Short broken hairs that taper toward the scalp — best seen on trichoscopy at the edge of a patch.
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Eyelash or eyebrow loss
Loss beyond the scalp — affects appearance and eye protection, and often bothers people most.
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Beard involvement
Round bald patches in the beard (alopecia barbae) — a common site in men.
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Red-flag features
Rapid extensive progression with psychological crisis — needs urgent dermatology and mental-health support.
Treatment
How alopecia areata is treated in the UK.
Topical and intralesional steroids first, with a modern ladder that reaches oral JAK inhibitors when disease is severe.
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Topical corticosteroid
Potent topical steroid to reduce inflammation around follicles — used for limited patchy disease.
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Intralesional triamcinolone
Steroid injected directly into bald patches — often the most effective option for limited disease.
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Topical minoxidil (adjunct)
Used alongside other treatments to encourage regrowth — not a treatment for the autoimmune process itself.
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Contact immunotherapy (DPCP)
Diphencyprone applied to the scalp to induce a controlled allergic response — a specialist option for extensive disease.
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Baricitinib (oral JAK for severe)
Oral JAK1/2 inhibitor — licensed for severe adult alopecia areata and can produce meaningful regrowth.
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Ritlecitinib (adolescents & adults)
Oral JAK3/TEC inhibitor — licensed from age 12 for severe alopecia areata.
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Wigs and camouflage
NHS wigs, hair systems, scalp micropigmentation and eyebrow tattooing — practical, dignified and effective.
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Psychological support
Alopecia UK peer support, counselling and CBT — the impact on identity and mood is real and treatable.
What this guide is based on
The sources behind every claim on this page.
UK and international specialist society standards and patient organisations, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or dermatologist knows your history and can tell you which parts apply to you. If in doubt, get seen.
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British Association of Dermatologists (BAD). Patient information leaflet on alopecia areata.
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Alopecia UK. Patient information and support.
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European Society of Hair Research. Consensus statements on alopecia areata.
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US National Alopecia Areata Foundation. Patient and clinician resources.
Red flags
When alopecia areata needs urgent attention.
Most alopecia areata is patchy and manageable. These are the situations where it isn’t — and you should act sooner rather than later.
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Rapid extensive progression
A patch spreading fast — arrange dermatology review promptly for consideration of systemic treatment.
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Alopecia universalis
Loss of scalp and body hair together — needs specialist care and a full discussion of oral JAK inhibitors.
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Comorbid autoimmune features
Weight change, cold intolerance or GI symptoms — check thyroid function and coeliac serology.
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Suicidality from cosmetic impact
The psychological toll can be severe — urgent mental-health support alongside dermatology.
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Post-JAK infection
Fever, cough or shingles-like rash on baricitinib or ritlecitinib — contact the prescribing team the same day.
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Trichotillomania overlap
Broken hairs of varying length and unusual patch shapes — behavioural cause needs a different pathway.
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Scarring alopecia mimics
Lichen planopilaris and frontal fibrosing alopecia can look similar early — scarring loss is permanent, needs urgent referral.
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Tinea capitis in children
Scaly patches with broken hairs and lymph nodes — a fungal infection needing oral antifungals, not steroids.
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Nutritional-deficiency mimics
Iron, vitamin D or zinc deficiency, and thyroid disease, can cause diffuse shedding that is not alopecia areata.
Living with it
An unpredictable condition, but a very treatable one.
Four things that make the biggest difference — early specialist care, mental-health support, practical camouflage and objective review.
A quiet reminder
The emotional side is part of the condition.
Good care treats both the follicle and the person — support and camouflage sit alongside the medicine, not after it.
- 01 Care
Get seen early
Early dermatology input opens the door to injections and oral options that work best before disease is extensive.
- 02 Mind
Take the psychological side seriously
Alopecia UK peer support and counselling are not optional extras — they change outcomes.
- 03 Practical
Wigs and camouflage help
NHS wigs, hair systems, brow tattooing and scalp micropigmentation restore confidence while treatment works.
- 04 Review
Track response objectively
SALT and DLQI at each visit tell you if a treatment is working — better than memory alone.
Frequently asked
Everything we get asked about alopecia areata.
Quick answers on regrowth, tests, JAK inhibitors and when to see a specialist.
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What is alopecia areata?
An autoimmune condition in which the immune system attacks hair follicles, causing non-scarring hair loss. Because the follicles are not destroyed, hair can regrow.
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Will my hair grow back?
Often, yes — especially in limited patchy disease. Extensive forms are less predictable, but oral JAK inhibitors have meaningfully improved outcomes in severe disease.
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Do I need any tests?
The diagnosis is clinical, supported by trichoscopy. Thyroid function and coeliac serology are commonly checked because of the autoimmune overlap.
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What are baricitinib and ritlecitinib?
Oral JAK inhibitors licensed for severe alopecia areata. Baricitinib is used in adults; ritlecitinib is licensed from age 12. Both are prescribed by dermatology specialists.
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Is alopecia areata linked to other conditions?
Yes — it overlaps with atopy (eczema, hay fever, asthma) and autoimmune thyroid disease. That is why simple blood tests are often arranged at diagnosis.
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When should I see a specialist?
For rapidly progressive or extensive disease, alopecia totalis or universalis, or when standard topical and intralesional treatment has not helped.
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