Alopecia areata
Also known as: alopecia areata, patchy alopecia areata, alopecia totalis, alopecia universalis, ophiasis alopecia, sisaipho alopecia, diffuse alopecia areata, autoimmune non-scarring hair loss
Alopecia areata is an autoimmune, non-scarring hair-loss disorder in which immune activity targets anagen hair follicles. It commonly presents as one or more smooth, well-defined patches of hair loss on the scalp, beard, eyebrows, eyelashes or other hair-bearing areas. More extensive forms include alopecia totalis (complete or near-complete scalp-hair loss) and alopecia universalis (extensive body-hair loss). Exclamation-mark hairs, broken hairs, yellow dots and black dots may be seen on dermoscopy. Nail pitting, ridging or roughness can occur and may be associated with more extensive disease. Alopecia areata can begin at any age, follow an unpredictable relapsing course and undergo spontaneous regrowth, although recurrence is common. It is associated with other autoimmune or atopic conditions including autoimmune thyroid disease, vitiligo and atopic dermatitis. Diagnosis is usually clinical but dermoscopy, laboratory testing or scalp biopsy may be required when the presentation is atypical. Biomedical management depends on age, disease duration, activity, extent, location and patient preference — options include observation, topical or intralesional corticosteroids, topical minoxidil as an adjunct, contact immunotherapy, systemic corticosteroids, immunomodulatory medicines and approved oral Janus kinase inhibitors for selected patients with severe disease[1][2][5][6]. TCM differentiation commonly includes Blood deficiency generating Wind, Liver and Kidney deficiency, Qi and Blood deficiency, Liver Qi stagnation with Blood stasis, Blood Heat generating Wind or Spleen deficiency with Dampness. Acupuncture and Chinese herbal medicine may be considered as adjunctive support but must not replace dermatological diagnosis, screening for alternative causes of hair loss, evidence-based treatment or monitoring of systemic immunomodulatory medicines.
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Lifestyle & Diet
- •Arrange medical or dermatological assessment to confirm alopecia areata and exclude fungal infection, scarring alopecia, patterned hair loss, telogen effluvium and other causes.
- •Take prescribed topical, injected or systemic treatments according to the dermatologist's instructions.
- •Do not stop corticosteroids, Janus kinase inhibitors or other immune-modifying medicines abruptly without advice from the prescriber.
- •Attend recommended blood tests and safety monitoring for systemic medicines.
- •Report fever, serious infection symptoms, shingles, chest pain, breathing difficulty or unusual swelling promptly when receiving systemic immunomodulatory treatment.
- •Use gentle hair and scalp care and avoid repeated tight hairstyles, harsh bleaching, chemical relaxers or traction over vulnerable areas.
- •Cosmetic camouflage, hair fibres, wigs, scarves, hats, eyebrow products and false eyelashes may support quality of life according to personal preference.
- •Use sunscreen or protective headwear on exposed scalp because hair loss reduces UV protection.
- •Protect exposed scalp from cold weather.
- •Glasses may help protect the eyes when eyelashes are absent.
- •Avoid unregulated supplements marketed as guaranteed hair-loss cures.
- •Do not take high-dose biotin without discussing it with a clinician because it can interfere with some laboratory tests.
- •Do not take iron, zinc, selenium or vitamin A supplements in high doses unless deficiency has been established; excess intake can be harmful and may worsen hair loss.
- •Maintain adequate protein, energy, iron, zinc, vitamin D and other nutrients through a balanced diet.
- •Avoid crash dieting and prolonged fasting.
- •Document hair loss with consistent photographs if this does not worsen distress.
- •Discuss thyroid or other autoimmune screening with a clinician when symptoms, personal history or family history suggest it.
- •Seek psychological support when hair loss affects mood, identity, relationships, school, employment or social participation.
- •Connect with reputable alopecia support organisations when peer support would be helpful.
- •Explain to children, schools and caregivers that alopecia areata is not contagious.
- •Avoid blaming emotional stress, diet or personal behaviour for causing the condition.
- •Spontaneous hair regrowth can occur, but recurrence and changes in disease extent are possible.
Cautions & Contraindications
- •Do not treat suspected tinea capitis, bacterial scalp infection or scarring alopecia with acupuncture or herbs alone.[]
- •Do not delay dermatological assessment for rapidly spreading or extensive hair loss.[,]
- •Do not claim that acupuncture or Chinese herbal medicine cures alopecia areata or permanently prevents relapse.
- •Do not advise discontinuation of topical corticosteroids, intralesional therapy, minoxidil, contact immunotherapy or systemic treatment without consultation with the prescriber.
- •Do not describe alopecia areata as solely stress-related, nutritional or caused by poor circulation.
- •Do not interpret scalp redness, pain, scale or loss of follicular openings as a healing reaction.
- •Avoid needling infected, ulcerated or actively inflamed scalp tissue.
- •Avoid aggressive plum-blossom, dermaroller, bleeding or scraping techniques in patients with anticoagulant use, thrombocytopenia, impaired healing or immune suppression.
- •Do not use unsterile or shared skin-penetrating scalp devices.[,]
- •Do not apply irritant herbal tinctures, essential oils or caustic substances to the scalp without appropriate safety assessment.
- •Do not use oral or topical products containing undisclosed corticosteroids or pharmaceutical ingredients.
- •Hé Shǒu Wū requires particular caution because clinically significant liver injury can occur.
- •Bǔ Gǔ Zhī may cause liver injury and photosensitivity.
- •Dāng Guī, Chuān Xiōng, Dān Shēn, Táo Rén, Hóng Huā and similar Blood-moving herbs require pregnancy, bleeding-risk and anticoagulant review.
- •Gān Cǎo may affect blood pressure, potassium and medicine metabolism when concentrated or used for prolonged periods.
- •Fù Zǐ must be correctly processed and professionally prescribed because of cardiotoxicity and neurotoxicity.
- •Mù Tōng must be botanically verified and free of aristolochic acid.
- •Screen all herbal prescriptions for pregnancy, breastfeeding, childhood use, liver or kidney disease, allergies and interactions with immunosuppressants or other medicines.
- •Do not use adult herbal doses in children.
- •Do not recommend megadose vitamin or mineral supplementation without demonstrated need.
- •Do not use regrowth as proof that autoimmune activity has permanently resolved.
When to reassess or seek care again
- •Review at 2–4 weeks after starting acupuncture or herbal support to reassess disease activity, tolerability and adherence to dermatology-directed treatment.[,]
- •Reassess at 3 months for evidence of stabilisation, regrowth or spread; escalate to dermatology if disease is progressing or extent has increased.[,]
- •For severe or extensive disease receiving systemic immunomodulators or JAK inhibitors, coordinate with the prescribing specialist and attend all scheduled safety-monitoring bloods.[,]
- •Long-term: annual review of thyroid, iron and other autoimmune-associated conditions when symptoms or history suggest it.
- •New patches, rapid expansion of existing patches, or eyebrow/eyelash involvement — return to dermatology promptly.
- •Onset or worsening after significant stress, illness, childbirth or medicine change — review differentials including telogen effluvium.
- •Scalp pain, scale, pustules or loss of follicular openings appearing on a previously non-scarring patch — urgent dermatology review to exclude scarring alopecia or infection.
- •Systemic symptoms (fever, infection, chest pain, breathlessness, unilateral leg swelling) in a patient taking JAK inhibitors or systemic immunomodulators — seek urgent medical care.[,]
Spontaneous regrowth is common in limited patchy disease, and regrowth after acupuncture does not confirm treatment effect. Recurrence is common — set realistic expectations and maintain dermatology-led monitoring.
Frequently Asked Questions
What is alopecia areata?+
Alopecia areata is an autoimmune, non-scarring hair-loss disorder that commonly causes smooth, clearly defined patches of hair loss on the scalp, beard, eyebrows or other body areas [2].
Is alopecia areata contagious?+
No. Alopecia areata is not an infection and cannot be passed from one person to another [2].
Can hair regrow without treatment?+
Yes. Spontaneous regrowth is possible, particularly with limited patchy disease, but recurrence can occur and the course is unpredictable [2].
What are alopecia totalis and alopecia universalis?+
Alopecia totalis is complete or near-complete loss of scalp hair. Alopecia universalis is extensive loss of scalp, facial and body hair [2].
How is alopecia areata diagnosed?+
Diagnosis is usually based on the clinical pattern and dermoscopic findings. Blood tests or scalp biopsy may be used when another diagnosis or associated condition is suspected [8].
What biomedical treatments may be used?+
Options include observation, topical or intralesional corticosteroids, adjunctive minoxidil, contact immunotherapy, systemic corticosteroids, other immunomodulators and approved oral JAK inhibitors for selected severe cases [2].
What TCM patterns may be considered?+
Traditional patterns include Blood deficiency generating Wind, Liver-Kidney deficiency, Qi-Blood deficiency, Liver Qi stagnation with Blood stasis, Blood Heat generating Wind and Spleen deficiency with Dampness [8].
Can acupuncture or Chinese herbs cure alopecia areata?+
There is insufficient evidence that they cure the autoimmune disorder or permanently prevent relapse. They may only be considered adjunctively alongside dermatological care [8].
When should hair loss be referred urgently?+
Prompt referral is warranted for rapidly spreading hair loss, extensive disease, scalp pain or inflammation, scaling in a child, loss of follicular openings, systemic symptoms or severe psychological distress [2].
Are oral JAK inhibitors used for alopecia areata?+
Yes. Oral JAK inhibitors are approved in some jurisdictions for selected adults or adolescents with severe alopecia areata. They require specialist prescribing, screening and ongoing safety monitoring [2].
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Sources & Further Reading
Clinical guidance, red flags and safety notes on this page draw on the following current sources alongside the classical references above.
- American Academy of Dermatology · 2026
- NICE Clinical Knowledge Summaries · 2026
- DermNet · 2026
- Healthdirect Australia · 2026
- British Association of Dermatologists · 2026
- NICE · 2024
- US FDA · 2025
- World Health Organization · 2008
- World Health Organization · 2020
Educational reference for licensed practitioners. Not a substitute for individual clinical assessment. Refer to conventional care for any red-flag or undiagnosed presentation.