Alopecia

Alopecia areata is an autoimmune condition in which the immune system mistakenly attacks hair follicles, causing hair loss. It most classically presents as one or more well-defined, smooth, round patches of hair loss, often appearing suddenly, most commonly on the scalp but sometimes affecting eyebrows, eyelashes, or other body hair. In some people it can progress to more extensive hair loss — alopecia totalis (complete scalp hair loss) or alopecia universalis (loss of all body hair) — though many people experience only one or a few patches, sometimes with spontaneous regrowth.

Alopecia areata is associated with other autoimmune conditions, including thyroid disease and vitiligo, and often runs in families.

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Treatment depends on how extensive the hair loss is:

• Topical, intralesional, or oral corticosteroids — commonly used for localised patches, with intralesional injections directly into the affected area often used for smaller patches
• Topical minoxidil — sometimes used alongside other treatments to support regrowth
• Contact immunotherapy — a treatment that deliberately provokes a mild allergic skin reaction on the scalp, used for more extensive alopecia areata
• JAK inhibitors — a newer class of oral medication that targets the immune pathway driving alopecia areata. Baricitinib is TGA-approved for adults with severe alopecia areata, and ritlecitinib is TGA-approved for adolescents aged 12 and over — both represent a significant recent advance for more extensive disease, though neither is currently subsidised through the PBS, meaning there can be significant out-of-pocket cost

Because alopecia areata can be unpredictable — with some patches regrowing spontaneously and others persisting or recurring — your dermatologist will tailor treatment to the extent and pattern of your hair loss.

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