Scope of this summary
Children, adolescents and adults with suspected or confirmed alopecia areata affecting scalp or other hair-bearing sites. Scarring alopecia, tinea capitis, traction, trichotillomania, androgenetic alopecia and diffuse shedding require a different diagnostic and treatment pathway.
The Bottom Line
- Identify smooth nonscarring patches, exclamation-point hairs or broader scalp and body-hair loss, and inspect eyebrows, eyelashes, beard, nails and the scalp surface for clues to severity or an alternative diagnosis.
- Document baseline extent with a reproducible measure such as the Severity of Alopecia Tool plus eyebrow, eyelash, nail and quality-of-life impact; scalp percentage alone does not capture every serious consequence.
- Limited patchy disease may be observed or treated with local corticosteroid approaches chosen by age and site, while rapid progression, extensive loss or major functional or psychological impact warrants early dermatology review.
- Current US FDA-labeled systemic options include oral JAK-pathway medicines for defined severe populations; baricitinib is labeled for adults and ritlecitinib for adults and adolescents aged 12 years or older.
- Counsel that spontaneous regrowth and relapse both occur, that no response can be guaranteed, and that cosmetic camouflage, wigs, eyebrow or eyelash support and mental-health care are legitimate parts of treatment.
Practical clinical workflow
1
Establish onset, tempo, episode history, autoimmune context, medicines, infection, hair practices and distress; perform a full scalp and skin examination looking specifically for scale, inflammation, follicular loss and broken hairs.
2
Use dermoscopy, fungal testing, hair-pull assessment, biopsy or laboratory investigation selectively when a mimic, scarring process, diffuse loss or associated condition is plausible rather than ordering a fixed panel for everyone.
3
Record scalp extent and non-scalp involvement, photograph with consent, and discuss observation, local treatment or systemic referral in relation to age, duration, activity, prior response and patient priorities.
4
For severe disease, compare FDA-labeled options through dermatology, including age eligibility, likelihood and timing of response, maintenance needs, infection and cardiovascular risk and monitoring burden.
5
Follow hair growth, new loss, brows and lashes, nails, adverse effects and psychological impact; change course when disease progresses or the chosen intervention fails its defined review point.
Safety boundaries and escalation
- Loss of follicular openings, scalp pain, pustules, marked scale or inflammation suggests a scarring or infectious alopecia and requires prompt diagnostic assessment to prevent irreversible loss.
- Tinea capitis is contagious and needs systemic antifungal treatment; do not inject or immunosuppress an unconfirmed scaly or inflammatory patch.
- Severe distress, bullying, withdrawal, depression or suicidality needs active assessment and support independent of whether hair regrowth treatment is started.
- JAK-pathway medicines carry serious infection and other boxed or major warnings and require label-specific eligibility, vaccination, baseline evaluation, monitoring and interruption rules.
sources for this section:FDA Olumiant label 2026FDA Olumiant safety update 2026FDA Litfulo label 2026
Localization
Dermatologists should use the current FDA indication and label, evidence, patient values and payer authorization criteria separately. The AAD page is clinical education rather than a formal comprehensive alopecia-areata guideline.
Source documents
Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.
- American Academy of DermatologyAlopecia areata: Diagnosis and treatmentaccessed 2026-08-20view source
- U.S. Food and Drug AdministrationOLUMIANT (baricitinib) tablets, for oral use — Prescribing InformationNDA 207924/S-011 · Revised June 2026; includes the alopecia-areata indication and 2026 hypoglycemia warning · updated 2026-06-30 · accessed 2026-08-20view source
- U.S. Food and Drug AdministrationOlumiant (baricitinib) NDA 207924/S-11 Supplement ApprovalNDA 207924/S-11 · Reference ID 5826077 · June 2026 labeling revision for hypoglycemia risk in patients with diabetes · published 2026-06-30 · accessed 2026-08-20view source
- U.S. Food and Drug AdministrationLITFULO (ritlecitinib) capsules, for oral use — Prescribing InformationNDA 215830/S-001 · Reference ID 5826025 · Revised June 2026 · accessed 2026-08-20view source
continue the learning
From guidance to deliberate practice and evidence
Choose what happens next. iatroX can carry this page's jurisdiction, source-check date and released version into an editable learning record, support your reflection, or let you browse the regional question bank while keeping this topic visible. No action records completion, starts a session or awards CPD/CME credit automatically.
Add this guidance review to CPD/CMEOpen an editable learning-log record with this page’s provenance attached. You confirm the activity, time, reflection and mappings.Reflect on this with TutorUse optional prompts to consider what you learned and what—if anything—you may change. Suggestions are never inserted automatically.Browse the US question bankKeep this guidance topic in view, then choose your exam and filters. No session starts automatically.
Found a source update or regional discrepancy? Tell the iatroX editorial team.