Alopecia Areata: Etiopathogenesis, Diagnostics and Treatment – A Literature Review
DOI:
https://doi.org/10.12775/QS.2026.63.73396Keywords
alopecia areata, hair loss, trichoscopy, autoimmune disease, pathogenesis, JAK inhibitors, platelet-rich plasma, systemic treatmentAbstract
Background. Alopecia areata is an autoimmune disease affecting approximately 2% of the global population. It is characterized by non-scarring hair-loss and is closely linked to severe mental health issues and other allergic or autoimmune diseases.
Aim. The aim of this review is to summarize epidemiology, pathophysiology, diagnostics and treatment in Alopecia Areata.
Material and methods. This literature review includes articles from PubMed and publishers’ websites. The selection criteria specifically targeted clinical and scientific data published from the year 1995 onward, focusing on the management and characteristics of patients diagnosed with alopecia areata.
Results. The review demonstrates that Alopecia areata is driven by inflammatory response. Diagnostic approaches must include screening for other medical conditions and use trichoscopy to assess disease activity..
Conclusions. Alopecia areata requires an early and individualized approach that addresses both physical hair loss and psychiatric comorbidities. Modern targeted therapies offer results for severe cases, though future long-term clinical trials are necessary to establish standardized dosing regimens and minimize relapse rates after treatment discontinuation.
References
1. Ma T., Zhang T., Miao F., Liu J., Zhu Q., Chen Z., Tai Z., He Z. (2025) Alopecia Areata: Pathogenesis, Diagnosis, and Therapies, MedComm 6(5), e70182. https://doi.org/10.1002/mco2.70182
2. Thompson A.R., Tziotzios C., Nesnas J., Randall R., Czachorowski M., Messenger A. (2023) P67 Overall lifetime risk for alopecia areata is 2.1% and is higher in women, non-White ethnic groups and the most deprived: a UK population-based cohort study, British Journal of Dermatology, 188(Suppl. 4), ljad113.095. https://doi.org/10.1093/bjd/ljad113.095
3. Villasante Fricke A.C., Miteva M. (2015) Epidemiology and burden of alopecia areata: a systematic review. Clinical, Cosmetic and Investigational Dermatology, 8, 397–403. https://doi.org/10.2147/CCID.S53985
4. Wang D., Deng P., Yang S., Xu Y., Lu J. (2025) Global, Regional, and National Burden of Alopecia Areata and its Associated Comorbidities, 1990–2021, and Projections to 2050: An Analysis of the Global Burden of Disease Study 2021, Acta Derm Venereol 2025; 105: adv43367, https://doi.org/10.2340/actadv.v105.43367
5. Šutić Udović I., Hlaca N., Prpić Massari L., Brajac I., Kaštelan M., Vicić M. (2024) Deciphering the Complex Immunopathogenesis of Alopecia Areata, International Journal of Molecular Sciences 25(11), 5652 https://doi.org/10.3390/ijms25115652
6. Huang Y., Jee E., Kim M., Liu X., Jiang X. (2025) Familial patterns of alopecia areata: A systematic review and meta-analysis. Journal of Autoimmunity, 151, 103378. https://doi.org/10.1016/j.jaut.2025.103378
7. Friedrich A., Schmitz M.-T., Gossmann Y., Redler S., Blaumeiser B., Lutz G., Blume-Peytavi U., Nöthen M.M., Betz R.C., Basmanav F.B. (2025) Comorbid Bronchial Asthma, Atopic Dermatitis and Hashimoto's Thyroiditis Are Risk Factors for Early-Onset, Severe and Prolonged Alopecia Areata. Allergy, 80(4), 1158–1161. https://doi.org/10.1111/all.16468
8. Vañó-Galván S., Egeberg A., Piraccini B.M., Marwaha S., Reed C., Johansson E., Durand F., Bewley A. (2024) Characteristics and Management of Patients with Alopecia Areata and Selected Comorbid Conditions: Results from a Survey in Five European Countries. Dermatology and Therapy, 14(4), 1027–1037. https://doi.org/10.1007/s13555-024-01133-z
9. Senna M., Ko J., Tosti A., Edson-Heredia E., Fenske D.C., Ellinwood A.K., Rueda M.J., Zhu B., King B. (2021) Alopecia Areata Treatment Patterns, Healthcare Resource Utilization, and Comorbidities in the US Population Using Insurance Claims. Advances in Therapy, 38, 4646–4658. https://doi.org/10.1007/s12325-021-01845-0
10. Lepe K., Syed H.A., Zito P.M. (2024) Alopecia Areata. In: StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537000/ , PMID: 30020684
11. Hughes E.C., Syed H.A., Saleh D. (2024) Telogen Effluvium. In: StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430848/ , PMID: 28613598
12. Rakowska A., Rudnicka L., Olszewska M., Bergler-Czop B., Czuwara J., Brzezińska-Wcisło L., Narbutt J., Placek W., Zegarska B. (2023) Alopecia areata. Diagnostic and therapeutic recommendations of the Polish Dermatological Society. Part 1. Diagnosis and severity assessment. Przegląd Dermatologiczny, 110(2), 89–100. https://doi.org/10.5114/dr.2023.127704
13. Bastidas Torres D.M., Cantos Pesantez M.P., Espinoza Calle J.E., Gonzalez J.P.Y., Holguin Cagua D.J., Bravo Vinces K.L., Gomez Gonzalez R.C., Rojas Rojas D.M., Murillo Pineda P.F., Coello Garcia B.E. (2023) The pattern and clinical profile of alopecia areata: panoramic review: update and advances on etiopathogenesis, associated factors, diagnosis, complications, management and prognosis in treatment. EPRA International Journal of Multidisciplinary Research, 9(12), https://doi.org/10.36713/epra15118
14. Darwin E., Hirt P.A., Fertig R., Doliner B., Delcanto G., Jimenez J.J. (2018) Alopecia areata: Review of epidemiology, clinical features, pathogenesis, and new treatment options. International Journal of Trichology, 10(2), 51–60. https://doi.org/10.4103/ijt.ijt_99_17
15. Nikhil N., Mamatha P., Hanumanthayya K. (2020) A study of clinical and dermoscopic features in alopecia areata at a tertiary referral center. International Journal of Research in Dermatology, 6(6), 744–749. https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20204457
16. Al-Dhubaibi M.S., Alsenaid A., Alhetheli G., Abd Elneam A.I. (2023) Trichoscopy pattern in alopecia areata: A systematic review and meta-analysis. Skin Research and Technology, 29(6), e13378. https://doi.org/10.1111/srt.13378
17. Santos Lima C., Lemes L.R., Melo D.F. (2017) Yellow dots in trichoscopy: relevance, clinical significance and peculiarities. Anais Brasileiros de Dermatologia, 92(5), 724–726. https://doi.org/10.1590/abd1806-4841.20176157
18. Ardigò M., Tosti A., Cameli N., Vincenzi C., Misciali C., Berardesca E. (2011) Reflectance confocal microscopy of the yellow dot pattern in alopecia areata. Archives of Dermatology, 147(1), 61–64. https://doi.org/10.1001/archdermatol.2010.288
19. Jha A.K., Udayan U.K., Roy P.K., Amar A.K.J., Chaudhary R.K.P. (2017) Dermoscopy of alopecia areata—a retrospective analysis. Dermatology Practical & Conceptual, 7(2), 53–57. https://doi.org/10.5826/dpc.0702a12
20. Fathi H.B., Al Mallah M.N., Al Chalabi Q.S. (2023) Alopecia areata: trichoscopic markers in determining disease activity. Journal of the Egyptian Women’s Dermatologic Society, 20(3), 168–172. https://doi.org/10.4103/jewd.jewd_24_23
21. Gómez-Quispe H., Muñoz Moreno-Arrones O., Hermosa-Gelbard Á., Vañó-Galván S., Saceda-Corralo D. (2023) Trichoscopy in Alopecia Areata. Actas Dermo-Sifiliográficas, 114(1), 25–32. https://doi.org/10.1016/j.ad.2022.08.027
22. Sharma S., Kaur K., Kaur J., Bassi R. (2023) Trichoscopy in alopecia areata and trichotillomania. Portuguese Journal of Dermatology and Venereology, 81(4), 232–238. https://doi.org/10.24875/PJDV.23000053
23. Paun M., Tiplica G.S. (2023) Non-Invasive Techniques for Evaluating Alopecia Areata. Maedica – A Journal of Clinical Medicine, 18(2), 333–341. https://doi.org/10.26574/maedica.2023.18.2.333
24. Pelzer C., Iorizzo M. (2024) Alopecia Areata of the Nails: Diagnosis and Management. Journal of Clinical Medicine, 13(11), 3292. https://doi.org/10.3390/jcm13113292
25. Kushnir-Grinbaum D., Ghiya R., Frewen J., Yong S.S., Rathnayake D., Cranwell W., Wall D., Varathan V., Khosrotehrani K., Orchard D., Moussa A., Paranjape M., Sinclair R. (2025) Systemic Treatment of Moderate to Severe Alopecia Areata in Adults: Updated Australian Expert Consensus Statement. Australasian Journal of Dermatology, 66(7), e500–e508. https://doi.org/10.1111/ajd.14597
26. Abarca Y.A., Scott-Emuakpor R., Tirth J., Moroz O., Thomas G.P., Yateem D., Golbari R., Aphia N., Lysak Y., Narasimhan N., Siddiqui H.F. (2025) Alopecia Areata: Understanding the Pathophysiology and Advancements in Treatment Modalities. Cureus, 17(1), e78298. https://doi.org/10.7759/cureus.78298
27. Madani S., Shapiro J. (2013) Current treatment of alopecia areata. Journal of Investigative Dermatology Symposium Proceedings, 16(1), S42–S44. https://doi.org/10.1038/jidsymp.2013.14
28. Gaumond S.I., Kamholtz I., Jimenez J.J. (2025) Cytokine-Targeting Biologic Therapies for Alopecia Areata: A Comprehensive Review of Mechanism of Action, Clinical Efficacy, and Adverse Events. Biologics, 5(2), 11. https://doi.org/10.3390/biologics5020011
29. Gupta A.K., Carviel J.L., Foley K.A., Shear N.H., Piraccini B.M., Piguet V., Tosti A. (2019) Monotherapy for Alopecia Areata: A Systematic Review and Network Meta-Analysis. Skin Appendage Disorders, 5(6), 331–337. https://doi.org/10.1159/000501940
30. Mubki T, Zainalabidin R. Severe alopecia areata:Analysis of treatment outcome. Imam J Appl Sci 2019;4:78-82 https://doi.org/10.4103/ijas.ijas_13_19
31. Rakowska A., Rudnicka L., Olszewska M., Bergler-Czop B., Czuwara J., Brzezińska-Wcisło L., Narbutt J., Placek W., Zegarska B. (2023) Alopecia areata. Diagnostic and therapeutic recommendations of the Polish Society of Dermatology. Part 2: Treatment. Przegląd Dermatologiczny, 110(2), 101–120. https://doi.org/10.5114/dr.2023.127705
32. Lepe K., Syed H.A., Zito P.M. (2024) Alopecia Areata. In: StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537000/ , PMID: 30725685
33. Gregoire, S., McIntosh, B., Sanchez, K. et al. (2025) Local Corticosteroids for Alopecia Areata: A Narrative Review. Dermatol Ther (Heidelb) 15, 1607–1631. https://doi.org/10.1007/s13555-025-01421-2
34. Majewski M., Gardaś K., Waśkiel-Burnat A., Ordak M., Rudnicka L. (2024) The Role of Minoxidil in Treatment of Alopecia Areata: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 13(24), 7712. https://doi.org/10.3390/jcm13247712
35. Parikh A.K., Tan I.J., Wolfe S.M., Cohen B.A. (2024) Advances in topical therapies for clinically relevant and prevalent forms of alopecia. Life, 14(12), 1577. https://doi.org/10.3390/life14121577
36. Mahasaksiri T, Kositkuljorn C, Anuntrangsee T, Suchonwanit P. Application of Topical Immunotherapy in the Treatment of Alopecia Areata: A Review and Update. Drug Des Devel Ther. 2021;15:1285-1298 https://doi.org/10.2147/DDDT.S297858
37. Nowaczyk, J., Makowska, K., Rakowska, A. et al. Cyclosporine With and Without Systemic Corticosteroids in Treatment of Alopecia Areata: A Systematic Review. Dermatol Ther (Heidelb) 10, 387–399 (2020). https://doi.org/10.1007/s13555-020-00370-2
38. Husein-ElAhmed, H., & Steinhoff, M. (2022). Efficacy and predictive factors of cyclosporine A in alopecia areata: a systematic review with meta-analysis. Journal of Dermatological Treatment, 33(3), 1643–1651. https://doi.org/10.1080/09546634.2021.1886230
39. Sun Y, Li Q, Zhang Y and Liu Y (2025) Janus kinase inhibitors for alopecia areata: a review of clinical data. Front. Immunol. 16:1577115. https://doi.org/10.3389/fimmu.2025.1577115
40. Wu, W.-S., Chen, L.-R., & Chen, K.-H. (2025). Platelet-Rich Plasma (PRP): Molecular Mechanisms, Actions and Clinical Applications in Human Body. International Journal of Molecular Sciences, 26(21), 10804. https://doi.org/10.3390/ijms262110804
41. Arabzadeh Bahri R., Maleki S., Shafiee A., Ghandi N., Abedini R., Ehsani A.H., Ehsani A., Razavi Z. (2023) Efficacy and safety of platelet-rich plasma therapy in alopecia areata patients: a systematic review. Dermatologic Therapy, 2023, Article ID 8827644. https://doi.org/10.1155/2023/8827644
42. Darwish R, Zakhary M, Wingate K, et al. (July 14, 2025) From Cells to Strands: A Systematic Review Comparing Exosome Therapy, Platelet-Rich Plasma, and Minoxidil for Androgenetic Alopecia Treatment. Cureus 17(7): e87875. doi: 10.7759/cureus.87875
43. Meznerics, F. A., Illés, K., Dembrovszky, F., Fehérvári, P., Kemény, L. V., Kovács, K. D., Wikonkál, N. M., Csupor, D., Hegyi, P., & Bánvölgyi, A. (2022). Platelet-Rich Plasma in Alopecia Areata—A Steroid-Free Treatment Modality: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Biomedicines, 10(8), 1829. https://doi.org/10.3390/biomedicines10081829
44. Tan, L. S., Chan, M. M. H., Tan, D. J. A., Lee, J. S. S., & Chong, W. S. (2020). Effectiveness of Paint Psoralen and Ultraviolet-A in Alopecia Areata - Our Experience in the National Skin Center. Indian journal of dermatology, 65(3), 199–203. https://doi.org/10.4103/ijd.IJD_400_18
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Copyright (c) 2026 Karolina Oleksińska, Karolina Pracoń, Maria Pietrzak, Marcela Łupina-Romaniuk, Julia Kołodziejczyk, Aneta Chawryło, Dominika Piecuch, Gabriela Świetlicka, Paulina Pietraś, Michał Stolarczyk
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