Alopecia areata: a review on diagnosis, immunological etiopathogenesis and treatment options

Clin Exp Med. 2021 May;21(2):215-230. doi: 10.1007/s10238-020-00673-w. Epub 2021 Jan 1.


Patients suffering from alopecia areata (AA) can lose hair in focal regions, the complete scalp, including eyelashes and eyebrows, or even the entire body. The exact pathology is not yet known, but the most described theory is a collapse of the immune privilege system, which can be found in some specific regions of the body. Different treatment options, local and systemic, are available, but none of them have been proven to be effective in the long term as well for every treatment there should be considered for the possible side effects. In many cases, treated or non-treated, relapse often occurs. The prognosis is uncertain and is negatively influenced by the subtypes alopecia totalis and alopecia universalis and characteristics such as associated nail lesions, hair loss for more than 10 years and a positive familial history. The unpredictable course of the disease also makes it a mental struggle and AA patients are more often associated with depression and anxiety compared to the healthy population. Research into immunology and genetics, more particularly in the field of dendritic cells (DC), is recommended for AA as there is evidence of the possible role of DC in the treatment of other autoimmune diseases such as multiple Sclerosis and cancer. Promising therapies for the future treatment of AA are JAK-STAT inhibitors and PRP.

Keywords: Alopecia areata; Dendritic cells; Immunology; Langerhans cells; Treatment.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Alopecia Areata / diagnosis
  • Alopecia Areata / etiology
  • Alopecia Areata / immunology
  • Alopecia Areata / therapy*
  • Dendritic Cells / immunology
  • Humans
  • Immunotherapy
  • Janus Kinase Inhibitors / therapeutic use
  • Minoxidil / therapeutic use
  • PUVA Therapy
  • Platelet-Rich Plasma
  • Prognosis
  • STAT Transcription Factors / antagonists & inhibitors


  • Adrenal Cortex Hormones
  • Janus Kinase Inhibitors
  • STAT Transcription Factors
  • Minoxidil