What are the key features of alopecia areata. How is alopecia areata diagnosed using dermoscopy. What are the various presentations of alopecia areata across different body areas. How does alopecia areata progress and what are the potential treatment options.

Demystifying Alopecia Areata: An Overview of the Autoimmune Hair Loss Condition

Alopecia areata is an autoimmune condition characterized by sudden, patchy hair loss. This disorder can affect any hair-bearing area of the body, but it most commonly manifests on the scalp. The condition’s hallmark is the appearance of smooth, round patches of baldness that can vary in size and number.

While the exact cause of alopecia areata remains unknown, it’s believed to result from the immune system mistakenly attacking hair follicles. This autoimmune response disrupts normal hair growth cycles, leading to sudden hair loss. The condition can affect people of all ages and races, though it often begins in childhood or early adulthood.

Key Features of Alopecia Areata

• Sudden onset of hair loss
• Round or oval patches of baldness
• Smooth, hairless skin in affected areas
• No scarring or skin changes in bald patches
• Potential involvement of any hair-bearing area
• Unpredictable course with periods of remission and recurrence

Diagnostic Tools: The Role of Dermoscopy in Alopecia Areata

Dermoscopy has emerged as a valuable non-invasive tool for diagnosing and monitoring alopecia areata. This technique allows dermatologists to visualize specific features of the scalp and hair follicles that are characteristic of the condition.

Dermoscopic Findings in Alopecia Areata

How do dermatologists use dermoscopy to identify alopecia areata? Dermoscopy reveals several distinctive features:

• Yellow dots: These represent empty hair follicles filled with sebum and keratin.
• Black dots: Broken hairs within the follicular opening.
• Exclamation mark hairs: Short hairs that are thicker at the distal end and thinner at the proximal end.
• Pigtail hairs: Short, coiled hairs indicating regrowth.

These dermoscopic signs help differentiate alopecia areata from other forms of hair loss and can provide insights into the disease’s activity and progression.

Varied Presentations: Alopecia Areata Across Different Body Areas

While alopecia areata is most commonly associated with scalp hair loss, it can affect any hair-bearing area of the body. Understanding these varied presentations is crucial for accurate diagnosis and management.

Scalp Involvement

The scalp is the most frequently affected area in alopecia areata. Patients typically present with one or more round, smooth bald patches. In some cases, the hair loss can be more extensive, leading to total scalp hair loss (alopecia totalis) or complete body hair loss (alopecia universalis).

Beard Area

Alopecia areata can also manifest in the beard area, particularly in men. This presentation can be distressing and may impact self-esteem. The patches of hair loss in the beard follow the same pattern as those on the scalp, appearing as smooth, round areas devoid of hair.

Eyebrows and Eyelashes

In some cases, alopecia areata can affect the eyebrows and eyelashes. This can result in partial or complete loss of these hairs, which play important roles in facial expression and eye protection.

The Progression of Alopecia Areata: Understanding the Disease Course

Alopecia areata is known for its unpredictable course. The progression of the disease can vary significantly from person to person, making it challenging to predict outcomes.

Patterns of Hair Loss

What are the common patterns of hair loss in alopecia areata? The condition typically presents in one of three patterns:

1. Patchy alopecia areata: The most common form, characterized by one or more round patches of hair loss.
2. Alopecia totalis: Complete loss of scalp hair.
3. Alopecia universalis: Loss of all body hair, including eyebrows, eyelashes, and body hair.

Disease Activity and Remission

Alopecia areata is characterized by periods of active hair loss followed by remission. During active phases, new patches may appear or existing ones may expand. In remission, hair regrowth can occur, sometimes even in long-standing bald areas.

Is hair regrowth in alopecia areata permanent? Unfortunately, regrowth is not always permanent. Many patients experience cycles of hair loss and regrowth throughout their lives.

Microscopic Insights: Understanding Hair Shaft Changes in Alopecia Areata

Microscopic examination of affected hairs in alopecia areata reveals distinctive changes that provide valuable insights into the disease process.

Exclamation Mark Hairs

One of the most characteristic features of alopecia areata is the presence of exclamation mark hairs. These hairs are short and broken, with a distinctive shape resembling an exclamation point. The hair shaft is thinner at the proximal end (closer to the scalp) and thicker at the distal end.

Why do exclamation mark hairs form in alopecia areata? This unique shape results from the inflammatory process attacking the hair follicle. The weakened hair breaks off, leaving behind the characteristic exclamation mark appearance.

Trichorrhexis Nodosa

Another microscopic finding in alopecia areata is trichorrhexis nodosa, a condition where the hair shaft develops weak points that can easily break. This contributes to the fragility of hair in affected areas.

Treatment Approaches: Managing Alopecia Areata

While there is no cure for alopecia areata, several treatment options can help manage the condition and promote hair regrowth.

Topical Treatments

• Corticosteroids: Applied directly to the affected areas to reduce inflammation.
• Minoxidil: A hair growth stimulant that can be used alone or in combination with other treatments.
• Anthralin: A tar-like substance that may help stimulate hair regrowth.

Systemic Treatments

For more severe or widespread cases, systemic treatments may be considered:

• Oral corticosteroids: Used in short courses to suppress the immune response.
• JAK inhibitors: A newer class of medications showing promise in clinical trials.
• Immunosuppressants: Drugs like methotrexate or cyclosporine may be used in severe cases.

Other Approaches

What additional therapies can be used to manage alopecia areata? Several other approaches may be beneficial:

• Phototherapy: Exposure to specific wavelengths of light may stimulate hair regrowth.
• Platelet-rich plasma (PRP) therapy: Injection of growth factors derived from the patient’s own blood.
• Scalp micropigmentation: A cosmetic procedure that can camouflage areas of hair loss.

Living with Alopecia Areata: Psychosocial Impact and Coping Strategies

The impact of alopecia areata extends beyond physical hair loss. Many individuals with the condition experience significant psychosocial challenges that can affect their quality of life.

Emotional and Psychological Effects

How does alopecia areata affect a person’s emotional well-being? The condition can lead to:

• Decreased self-esteem and confidence
• Anxiety and depression
• Social isolation
• Body image issues

Coping Strategies

Developing effective coping strategies is crucial for individuals living with alopecia areata. Some helpful approaches include:

• Joining support groups to connect with others facing similar challenges
• Exploring hair alternatives such as wigs, hairpieces, or scalp micropigmentation
• Practicing stress-reduction techniques like meditation or yoga
• Seeking professional counseling or therapy when needed

By addressing both the physical and emotional aspects of alopecia areata, individuals can better manage the condition and maintain a positive outlook.

Research Horizons: Future Directions in Alopecia Areata Treatment

The field of alopecia areata research is rapidly evolving, with new treatments and therapeutic approaches on the horizon.

JAK Inhibitors: A Promising Frontier

Janus kinase (JAK) inhibitors have emerged as a promising class of medications for treating alopecia areata. These drugs work by modulating the immune response that leads to hair loss.

How do JAK inhibitors work in alopecia areata? They target specific pathways in the immune system, potentially “resetting” the immune response and allowing hair follicles to resume normal function.

Gene Therapy and Stem Cell Research

Ongoing research is exploring the potential of gene therapy and stem cell treatments for alopecia areata. These cutting-edge approaches aim to address the underlying genetic and cellular mechanisms of the disease.

Personalized Medicine Approaches

As our understanding of the genetic and immunological factors contributing to alopecia areata grows, there is increasing interest in developing personalized treatment strategies. These tailored approaches may help improve treatment outcomes by targeting the specific underlying causes in each individual.

The future of alopecia areata treatment holds promise for more effective and targeted therapies. Ongoing research and clinical trials continue to expand our understanding of this complex condition, offering hope for improved management and potential cures in the years to come.

Alopecia Areata Images — DermNet

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Extensive patchy alopecia areata

Alopecia areata: beard

Alopecia areata: dermoscopy

A single patch of alopecia areata

(AA-patient1)

Dermoscopic image showing normal follicular openings with vellus hairs

(AA-patient1)

A single patch of alopecia areata on the vertex

(AA-patient2)

Dermoscopic image of alopecia areata showing yellow dots; follicular infundibulae are filled with keratinous material with no hair shafts. Black dots are also presented.

(AA-patient2)

Thinning of the hair shaft at the proximal end (blue arrow) with normal thickness at the distal end (red arrow)

Dermoscopic image of alopecia areata presenting with exclamation mark hairs

Dermoscopic image of alopecia areata showing a pigtail hair: short twisted hair representing a regrowing hair

Dermoscopic image of noncicatricial alopecia areata presenting with small, uniform, regularly distributed follicular yellow dots

A trichoscopic image of alopecia areata showing an exclamation mark hair

Dermoscopic image of a patient with dark skin phototype showing honeycomb pattern; white-coloured follicular opening with reticular background.

Dermoscopic image of alopecia areata showing pigment from hair dye

Dermoscopic image of long standing alopecia areata showing Pohl-Pinkus constriction; irregular fusiform narrowings of the hair shaft

Dermoscopic image of the scalp on a female patient with longstanding alopecia areata showing white areas denoting fibrosis

Dermoscopic image of a male patient with alopecia areata showing multiple exclamation mark hairs (denoted by black arrows)

Dermoscopic image of a male patient with alopecia areata showing tapered hair (Red arrow) and regrowing hair (Yellow arrow)

Extensive alopecia areata with retention of grey hairs

Alopecia areata on the lateral scalp

(AA-patient3)

Alopecia areata with fine hypopigmented regrowing hairs

(AA-patient3)

Alopecia areata showing fine regrowing hairs

(AA-patient3)

Alopecia totalis

Patch alopecia areata with poliosis in a 14 year old

Alopecia areata of the top of the scalp

Several patches of alopecia areata on the scalp

(AA-patient4)

Extensive patchy alopecia areata

(AA-patient4)

Ophiasic pattern alopecia areata

(AA-patient5)

Ophiasic pattern alopecia areata

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Baldness (alopecia) – causes, types, approaches to treatment (Alopecia: the most common forms of baldness)

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Alopecia is hair loss that goes beyond the physiological norm, i.e. alopecia means increased (not directly associated with damage to the hair follicle), or pathological (associated with damage to the hair follicle) hair loss.

As you know, several stages are distinguished in the life cycle of an individual hair: growth, transitional phase and loss. Under the influence of various factors, the duration of these phases can change, which leads to severe hair loss and baldness. This problem occurs in both men and women, and the success of treatment largely depends on the timeliness of seeking qualified competent help.

Causes of hair loss on the head

It is known that the tendency to hair loss can be genetically determined (programmed), but there are a number of other reasons that can contribute to the development of alopecia. Among them are noted:

• Regular stress;
• Hormone imbalance;
• Childbirth and the puerperium;
• Unbalanced nutrition and uncontrolled diets;
• Poor ecological situation;
• Mechanical or chemical damage to the scalp;
• Infectious processes.

In addition, hair loss may develop with specific treatments. Alopecia is often noted in patients who have undergone chemotherapy, as well as after long-term use of certain groups of antibiotics, antidepressants, systemic retinoids, or other drugs.

Establishing the cause of hair loss is one of the most important tasks for a trichologist, since further treatment and its effectiveness will depend on this.

Types and types of alopecia

Depending on the mechanism of hair growth disorders, two main types of alopecia are distinguished: non-scarring and cicatricial. In this case, the first type can be transformed into the second, in the absence of proper and timely treatment.

• Non-scarring alopecia is the most common, and can be either diffuse or focal. Such hair loss develops for reasons that are not associated with cicatricial damage to the hair follicle.
• Scarring alopecia is characterized by scarring and destruction of hair follicles due to inflammation, trauma or other causes. This is the most unfavorable type of hair loss in terms of prognosis.

Scarring alopecia can be caused by infections (viral, bacterial, fungal), physical trauma, thermal or chemical burns that cause pronounced inflammatory reactions, on the site of which connective tissue is formed, as well as in certain types of skin diseases (with discoid lupus erythematosus, Broca’s pseudopelade).

Types (forms) of hair loss

Both cicatricial and non-scarring types of alopecia are divided into types (or forms).

The most common forms of hair loss that occur in both men and women are:

• Androgenetic alopecia;
• Diffuse (telogen) alopecia;
• Alopecia areata or alopecia areata.

What is Androgenetic Alopecia

Androgenetic Alopecia is the most common form of hair loss in both sexes.

• In men , the process of baldness most often begins in adolescence and goes through several stages: at first it is a bilateral bald patch above the forehead, then a bald spot appears, which gradually expands from the forehead to the crown and, as a result, only a narrow strip of hair remains on the temples and back of the head.
• In women this type of alopecia progresses more slowly and usually reduces to diffuse hair thinning, also more pronounced in the fronto-parietal region.

Causes of androgenetic alopecia

The development of androgenetic alopecia at the present stage is associated:

• Firstly , with an increase in the activity of the 5-alpha reductase enzyme in the tissues of the hair follicle, which converts the inactive form of the male hormone testosterone into its more aggressive form dihydrotestosterone (DHT). As a result of such activity of the 5-alpha reductase enzyme around the cells of the hair follicle, the concentration of DHT increases, which causes a damaging effect, causing atrophy of the hair follicles in androgen-dependent zones (often the fronto-parietal zone).
• Secondly , increased sensitivity of the hair follicle cell receptors themselves to the normal level of DHT in androgen-dependent areas of the scalp
• Thirdly , androgenetic alopecia occurs in people with a hereditary predisposition, for this purpose genetic testing is carried out to determine the risk factors for baldness.

Androgenetic alopecia develops in stages and is assessed according to the Norwood scale (for men) and the Ludwig scale (for women).

Norwood scale

Ludwig scale

Diagnosis of androgenetic alopecia

Diagnosis of androgenetic alopecia is established on the basis of: trichoscopy and phototrichogram, blood test results obtained in the study of hormonal status , as well as additional methods of research in the detection of hormonal disorders.

Treatment of androgenetic alopecia

The main principles of treatment of anrogenetic alopecia are the use of antiandrogen drugs externally and internally, and symptomatic treatment of damage to the hair follicle, which was established during trichoscopy and phototrichogram (physiotherapy, mesotherapy for hair, laser treatment, plasma therapy, etc.)

What is diffuse alopecia

Diffuse (telogen) alopecia – is manifested by uniform active hair loss over the entire surface of the head in both sexes and develops under the influence of a stress factor and with improper unbalanced nutrition. In such cases, metabolic processes in the cells of the hair follicle are disrupted, which leads to a shortening of the growth phase and damage to the hair shaft. Diffuse alopecia never ends with the development of fibrosis and is best treated.

Diagnosis and treatment of diffuse alopecia

Diagnosis of diffuse alopecia is based on trichoscopy and phototrichogram. With the correct diagnosis, the elimination of factors leading to the development of alopecia and with well-chosen treatment, it is possible to achieve complete restoration of hair growth.

In the pathogenetic treatment of diffuse alopecia, drugs and methods are used that improve metabolic processes in the hair follicle.

What is alopecia areata

Alopecia areata is a consequence of autoimmune processes in which hair follicles are selectively affected. With this form of alopecia, the formation of foci in which hair does not grow is noted. These foci can have a different shape and size, can merge with each other, be located in different parts of the head and trunk. The exact causes and mechanisms of development of this form of hair loss have not been fully established. Due to autoimmune damage to the follicles, the hair rapidly transitions from the growth phase to the transition phase and the shedding phase.

Diagnosis and treatment of alopecia areata

Diagnosis is established on the basis of identification of typical foci of alopecia, local and general examination, data obtained during trichoscopy. Sometimes it happens that untreated alopecia areata turns into a universal form (loss of hair on the entire skin), which is less treatable. The main pathogenetic method of treatment is the elimination of inflammation in the lesion, the use of drugs that reduce the activity of autoimmune aggression, followed by stimulating treatment.

In our clinic, in order to determine the type and type of alopecia, a trichologist prescribes a comprehensive examination, which includes anamnesis, general examination of the patient, clinical and instrumental examination, mandatory trichoscopy and phototrichogram and other types of diagnostics.

How to treat hair loss on the head

Modern methods of treating alopecia are effective, but not always allow you to achieve complete restoration of the hairline. However, in almost every case, you can achieve some improvement and slow down the process of hair loss as much as possible.

The following therapies can be used for this:

• Hormonal treatment;
• Preparations which improve the nutrition of the hair follicle;
• Anti-inflammatory therapy;
• Physiotherapy;
• Symptomatic treatment.

Effective treatment of any type of hair loss is not possible without eliminating the cause of the disease, if possible. For example, it will not be possible to eliminate genetic factors, but each person is able to change his diet and lifestyle, learn to control stress, etc.

During the course of treatment, the patient must be observed by a trichologist who monitors the dynamics of changes and, if necessary, corrects the scheme. It should be understood that the therapy of any form of alopecia requires a long time, so you should be patient and strictly follow all the recommendations of a specialist.

1. Consultation with a trichologist and trichoscopic hair examination

   3000
   rub

2. Phototrichogram

   2400
   rub

3. Trichoscopy

   1200
   rub

4. Plasma therapy of the scalp

   5400
   rub

5. Intradermal injection of drugs into the scalp with microelements, vitamins, etc. 2.5 ml

   2760
   rub

6. Mesotherapy of the scalp “Filorga NCTF 135” 1.5 ml

   4950
   rub

7. Mesotherapy of the scalp “Filorga NCTF 135” 3.0 ml

   6930
   rub

8. Mesotherapy of the scalp “HyalCode Zn” 1. 0% – 2.5 ml

   3960
   rub

9. Mesotherapy of the scalp “HyalCode Zn” 1.0% – 5.0 ml

   7700
   rub

10. Viscoderm Skinko scalp mesotherapy 2.5ml

    3750
    rub

11. Viscoderm Skinko scalp mesotherapy 5. 0 ml

    7150
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12. Mesotherapy of the scalp with hyaluronic acid “Hydro line” 2.0 ml

    2800
    rub

13. Scalp mesotherapy – for sparse and thin hair – “Hair System” Mesotech 5.0 ml

    4510
    rub

14. Scalp mesotherapy with vitamins and HairXpeptid peptide complex 2. 0 ml

    4500
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15. Mesotherapy of the scalp with vitamins “HairXVita Line B+” 1.0 ml

    2880
    rub

16. Intradermal injection of Kenalog into the affected area 1.0 ml

    3000
    rub

17. Intradermal injection of Lidaza/Longidase into the affected area 1. 0 ml

    3000
    rub

18. Fractional mesotherapy of the scalp (excluding the cost of the drug)

    600
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19. Erbium laser treatment of the scalp (Photon)

    3600
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20. Carboxytherapy – injection of CO2 into the scalp

    2000
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Alopecia areata – Cosmedica Clinic

Team Cosmedica

We are an international team committed to providing the best hair transplant services on the market and to informing and educating people around the world about hair loss and its treatments.

Contents of the article

Millions of people suffer from a disease in which hair falls out in round patches . This disease is called alopecia areata (alopecia areata) .

Usually the disease occurs suddenly – one day everything is fine, then almost overnight the hair falls out and appears on the head round small bald patches .

Alopecia areata is an autoimmune disease , that is, the body’s immune system mistakenly identifies a body part as a foreign threat, such as a virus. It is one of the most common types of hair loss, surpassing only genetic hair loss in frequency of occurrence.

The most characteristic symptom of alopecia is round bald patches as the immune system attacks the hair follicles in this area, resulting in hair loss.

The factors that cause the development of alopecia are still not exactly clarified by doctors . In fact, to this day, this disease is a great mystery to doctors.

The facts are that it is an autoimmune disease and the second most common cause of hair loss, after the genetic hair loss known as androgenetic alopecia.

Many people consider baldness to be a traumatic or shocking event because it occurs suddenly. Because hair falls out in very distinct circles, hair loss can be very noticeable.

Alopecia areata causes.

Alopecia areata (alopecia areata) is an autoimmune disease. Suddenly and for no apparent reason, the body recognizes the hair follicles where the hair roots are formed as foreign bodies and starts attacking them accordingly.

This, in turn, leads to an inflammatory reaction in the affected area, causing the hair to fall out within a very short time .

Round or oval hairless areas remain, characteristic of this disease. Along their edges, broken hairs can be found.

In some cases, mostly pigmented hair falls out , while gray hairs remain . If a person has a lot of gray hair, then only they remain, which creates the impression that the person has turned gray prematurely.

The cause of alopecia areata has not yet been fully elucidated. As with hereditary hair loss (genetic predisposition), it is assumed that some people with alopecia areata are more prone to it than others. There is often a family history of the disease. In about 25% of cases, it also occurs in a family member or close relative.

In addition, people with trisomy 21 or white spot disease (vitiligo) often suffer from patchy hair loss. Symptoms also occur in association with thyroid disorders , such as Graves ‘ disease or Hashimoto . It is assumed that constant stress also sometimes provokes the development of alopecia areata.

Possible alopecia areata of the head, as well as the whole body.

Types and symptoms of alopecia areata

There are 5 different types of Areata alopecia:

• Alopecia multilobular – bald patches appear in several places on the head
• Single flap alopecia – hair falls out only in one place on the head
• total alopecia – all the hair on the head falls out0016
• Universal alopecia – instead of individual areas of hair loss, all body hair falls out
• Alopecia ophiasis – hair falls out in the form of a crown on the neck and ears (this is a special and unusual form of the disease).

The good news is that in all forms of alopecia areata, patient is able to grow hair after the episode ends.

However, the complexity of alopecia lies in the fact that the disease usually occurs in episodes.

This means, for example, that patchy hair loss can reappear as soon as the hair begins to grow. Quite often spotted or furrowed nails appear as a side symptom.

Alopecia areata in women

Alopecia areata in women treatment.

Women are more likely to suffer from baldness than men. And especially often women suffer greatly when their hair falls out all at once.

Lush hair and thick hair are still considered a sign of femininity, although there are more and more women who have made a bald head their calling card.

Otherwise, the wig can at least visually hide it. If the hair does not grow back properly after overcoming the disease, hair transplant may be the solution. You can find out about the service by clicking on the link hair transplant for women .

Male alopecia areata

In men, circular hair loss can also occur in the beard area ( beard alopecia areata ). The disease can also affect the eyebrows and (very rarely) can be observed in body hair .

If the beard is affected, the beard can be shaved during an attack of alopecia areata. Since the area around the affected area is also free of hair, this makes it almost invisible.

Especially in the case of Alopecia Areata multilobularis and Alopecia Areata unilocularis it is recommended to wear the headgear, at least as a temporary solution. If a person’s hair does not grow back properly after an episode, hair transplant in Turkey may be the solution. You can learn about the service by clicking on the link above.

Alopecia areata in children

Circular hair loss in children ( alopecia areata ) is surprisingly common. Typical symptoms of this disease appear almost overnight. These are round or slightly oval bald patches on the scalp.

Treatment of alopecia areata in children.

Many children grow their hair back within a year without medication . Sometimes steroid injections are used to suppress a local immune response. Alopecia areata can also be hereditary. Most young children suffering from circular hair loss are relatively calm about this condition. However, during adolescence, the situation can quickly change.

Alopecia areata treatment

How to treat alopecia areata?

Since the cause of the disease is not fully understood, there is no effective treatment for alopecia that would guarantee hair regrowth.

In mild cases of alopecia areata, hair grows back within three to six months . However, this self-healing can last for years.

A doctor, in this case a dermatologist, treats only the symptoms of the disease, e. g.0299 using zinc tablets . Therapy with cortisone and with prednisolone can also be effective. However, they are associated with huge side effects as the drugs suppress the immune system. It also makes the patient vulnerable to other diseases and medical conditions.

Meanwhile, great success has been achieved in the treatment of alopecia areata with topical immunotherapy . With this treatment, the scalp is sensitized by special allergens . The reaction thus elicited should stimulate hair growth.

In some cases, the immune response leading to baldness may be associated with prolonged and severe stress . It may happen that if the stress subsides, then the immune response also subsides, and normal hair growth can resume after a while.

However, the possibility of using such therapy always depends on the individual case. In addition, such treatment is carried out only in specialized medical practices or clinics.

In any case, if you suffer from alopecia areata, it is recommended that you consult your doctor.

Hair transplant for alopecia areata?

In principle, hair transplant is possible in alopecia areata. This is especially true when the hair no longer grows with the same density and bald patches remain.

However, it is very important that alopecia areata is completely cured . Otherwise, there is a risk that the immune system will attack the newly transplanted follicles and they will immediately fall out again.

A reputable trichologist will carefully examine the bald area to ensure that there is no risk of the immune system attacking the transplanted hair follicles again.

A good and reputable hair transplant clinic will never pressure you into having a hair transplant. In cases of alopecia areata, hair transplantation can give good results, but is only suitable under certain circumstances. In the wrong circumstances, it can do more harm than good.