SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferences

Information for Patients

View all Images (120)

Other Resources UpToDate PubMed

Alopecia areata in Adult

See also in: External and Internal Eye,Hair and Scalp,Nail and Distal Digit
Contributors: Vivian Wong MD, PhD, Sarah N. Robinson MD, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed


Alopecia areata is a T lymphocyte-mediated autoimmune disease of the hair follicle resulting in nonscarring hair loss. Most cases are limited to 1 or 2 small patches of alopecia that involve the scalp, eyebrows, eyelashes, or body hair, but in severe cases, all hair on the scalp is lost (alopecia totalis) or all scalp and body hair is lost (alopecia universalis). History of sudden onset is characteristic.

Alopecia areata is seen equally in both sexes and in patients of all ages, races, and ethnicities. There is an increased incidence of alopecia areata in patients with Down syndrome as well as those with autoimmune diseases, most commonly thyroid disease. Patients with alopecia areata are also more likely to have atopy, and its presence is felt to be a poor prognostic indicator.

While medication-induced alopecia areata has been uncommon in the literature, there have been articles published reporting an association with some medications, including the TNF inhibitors adalimumab, etanercept, and infliximab. Other more recently described culprit agents include proton pump inhibitors and immune checkpoint inhibitors (CTLA-4, PD-1) that are used to treat malignancies. Alopecia areata following COVID-19 infection and vaccination has also been reported. 

The course of alopecia areata is unpredictable, with wide variation in duration and extent of disease occurring from patient to patient. In most patients, hair will eventually spontaneously regrow, although recurrences are common. The condition is treatable but cannot be cured.

In one retrospective study of 321 patients, temporal area involvement was independently associated with worse prognosis (in addition to extent of hair loss).

A 2022 retrospective population-based study in Taiwan showed an increase in retinal diseases among 9909 patients with alopecia areata. The disease extent and prior steroid treatment were not commented on; further studies are needed to confirm an association.


L63.9 – Alopecia areata, unspecified

68225006 – Alopecia areata

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

  • Trichotillomania, from the twisting and pulling of hair, may mimic alopecia areata. Hair is broken off at varying lengths.
  • Telogen effluvium from nutritional, hormonal, and drug etiologies can lead to large clumps of hair loss in a similar fashion to alopecia areata. The loss is diffuse, not localized.
  • Tinea capitis has hair loss accompanied by scale and inflammation.
  • Secondary syphilis can result in diffuse patchy alopecia.
  • Androgenetic alopecia – Male pattern alopecia or Female pattern alopecia pattern
Scarring alopecia:
  • Pseudopelade
  • Central centrifugal cicatricial alopecia
  • Traction alopecia
  • Folliculitis decalvans

Best Tests

Subscription Required

Management Pearls

Subscription Required


Subscription Required

Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

Subscription Required


Subscription Required

Last Reviewed:01/21/2024
Last Updated:01/21/2024
Copyright © 2024 VisualDx®. All rights reserved.
Patient Information for Alopecia areata in Adult
Contributors: Medical staff writer
Premium Feature
VisualDx Patient Handouts
Available in the Elite package
  • Improve treatment compliance
  • Reduce after-hours questions
  • Increase patient engagement and satisfaction
  • Written in clear, easy-to-understand language. No confusing jargon.
  • Available in English and Spanish
  • Print out or email directly to your patient
Copyright © 2024 VisualDx®. All rights reserved.
Alopecia areata in Adult
See also in: External and Internal Eye,Hair and Scalp,Nail and Distal Digit
A medical illustration showing key findings of Alopecia areata (General) : Sparse eyebrows, Eyelash loss, Eyebrows
Clinical image of Alopecia areata - imageId=3997565. Click to open in gallery.  caption: 'A smooth round patch of nonscarring alopecia on the occipital scalp with early hair regrowth after intralesional steroid injection.'
A smooth round patch of nonscarring alopecia on the occipital scalp with early hair regrowth after intralesional steroid injection.
Copyright © 2024 VisualDx®. All rights reserved.