Round patches
Smooth, well-demarcated areas without obvious scarring.
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Autoimmune patchy hair loss · Dehradun
A smooth, round bald patch appeared suddenly? It could be alopecia areata.
Round bald patches · beard patches · eyebrow lossAlopecia areata is an immune-mediated condition in which inflammation disrupts normal hair growth, often causing sharply defined bald patches on the scalp, beard, eyebrows or other hair-bearing sites. It is not contagious, and regrowth is possible, though relapses can occur.
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Illustrative medical image. The appearance can vary; an examination is needed for diagnosis.
Recognise the pattern
Common signs of alopecia areata
These clues help distinguish one kind of hair loss from another—but images and symptoms alone cannot confirm a diagnosis.
Rapid onset
A patch can become noticeable over days or weeks.
Other areas
Beard, eyebrows, eyelashes or nails may also be involved.
Variable course
Some patches regrow; others enlarge or recur.
Understand the cause
What happens to hair follicles in alopecia areata?
In alopecia areata, immune inflammation interrupts hair growth without usually destroying the follicles. That is why regrowth remains possible even when the scalp looks completely smooth.
Some patients have one or two small patches. Others develop more extensive scalp or body hair loss. Nails may develop small pits or other changes. Its course is unpredictable: spontaneous regrowth can occur, but recurring episodes are also common.
Diagnosis first
How a dermatologist evaluates it
Clinical history and scalp examination guide whether trichoscopy, laboratory tests, microscopy or biopsy is needed. Not every patient requires all investigations.
Typical examination
Check shape and distribution of patches, eyebrow/beard involvement and nail changes.
Trichoscopy
Look for characteristic short broken hairs, exclamation-mark hairs and yellow or black dots, while distinguishing fungal infection and hair pulling.
Selective tests
Most typical cases can be diagnosed clinically. Thyroid assessment or other tests are considered when clinically indicated; routine broad autoimmune testing is not needed for everyone.
Different clinical patterns
Forms of alopecia areata
Alopecia areata does not always appear in the same way. Recognising the pattern helps patients understand why severity, prognosis and treatment choices can differ.
Patchy alopecia areata
The commonest form. One or more smooth, well-defined bald patches appear on the scalp, beard or other hair-bearing sites.
Alopecia totalis / universalis
Alopecia totalis means complete scalp-hair loss. Alopecia universalis means complete loss of scalp, facial and body hair.
Ophiasis and other patterns
Some patients develop band-like loss along the sides and back of the scalp, called ophiasis. Pattern and extent can influence treatment planning and prognosis.
Evidence-informed care
Treatment options — chosen for the diagnosis
Management depends on the actual condition, its severity, age, medical history and your goals. Procedures are not a replacement for treating the underlying cause.
Small or limited patches
Observation can be reasonable for selected small, recent patches. Topical corticosteroids or intralesional corticosteroid injections may be considered according to age, site and severity. Injections are most often used for a limited number of patches in suitable adults; they are not the right choice for everyone.
Extensive alopecia areata
Widespread disease may need specialist systemic therapy, sometimes including JAK inhibitors where approved, accessible and suitable. These treatments require careful screening, safety counselling and monitoring.
Supporting regrowth
Minoxidil may sometimes be used as an adjunct, but it does not replace treatment directed at the underlying immune process. With widespread or rapidly progressing disease, treatment choices need individual assessment.
Relapse planning
Follow-up matters because new patches or recurrence can develop even after apparent regrowth. Discuss expectations, psychological impact and alternative approaches where appropriate.
Intralesional steroid counselling: For suitable patients with limited patchy alopecia areata, injections may be repeated at intervals, often around 4–6 weeks. Regrowth takes time and cannot be guaranteed. Brief injection-site discomfort is possible; local adverse effects include skin thinning or indentations and lighter or darker skin. These changes are often reversible but can sometimes persist.
When to seek an earlier appointment: Rapidly expanding patches, significant eyebrow/eyelash loss, involvement of most scalp hair or major emotional distress deserve timely specialist review.
Realistic expectations
What follow-up usually looks like
Hair grows slowly. These are broad clinical milestones, not a guaranteed timetable for recovery or response.
At diagnosis
Confirm non-scarring alopecia and grade the extent of loss.
Next weeks/months
Observe for new patches and signs of regrowth; treatments need time.
Long-term
Regrowth and recurrence are both possible; management is individualised.
Common patient questions
Alopecia Areata FAQs
Clear answers without unrealistic promises or one-size-fits-all treatments.
Is alopecia areata a fungal infection?
No. It is an immune-mediated condition, although scalp fungal infection can mimic patchy hair loss.
Is it contagious?
No. Alopecia areata cannot be passed from one person to another.
Can beard hair be affected?
Yes. Alopecia areata may involve the beard, scalp, eyebrows and other hair-bearing sites.
Will hair grow back?
Many patients experience regrowth, but timing and completeness vary; patches can recur.
Are steroid injections used?
Yes. In selected adults with a few patches, intralesional corticosteroids are a common option. Repeat sessions may be needed; regrowth is gradual, and possible local effects include skin indentations, thinning and colour changes.
Do all patients need JAK inhibitors?
No. They are reserved for selected more severe cases where benefits, access, indications and monitoring needs justify treatment.
Patient education, not a personal prescription.
Do not begin or discontinue prescription treatments solely from a webpage. A dermatologist can identify overlapping disorders and discuss benefits, contraindications and follow-up. All clinical images on this page are AI-generated illustrations—not photographs of patients or treatment results.
Clinical reading: AAD: alopecia areata treatment · DermNet: alopecia areata case features
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Dr Neeraj Garg · MBBS (IMS-BHU), MD (IMS-BHU)
Maheshwari Hospital, Dalanwala, Dehradun · Consultation ₹800