ALOPECIA AREATA: CURRENT INSIGHTS INTO IMMUNOPATHOGENESIS, DIAGNOSIS, AND EVOLVING THERAPEUTIC STRATEGIES

Alopecia areata (AA) is a chronic autoimmune disorder leading to non-scarring hair loss and affecting millions worldwide across all age groups. Despite extensive research, the precise molecular mechanisms remain incompletely understood, arising from complex interactions among immune dysregulation, genetic susceptibility, and environmental triggers. Emerging evidence also implicates lifestyle factors, psychological stress, gut microbiome imbalance, and drug exposures in disease onset and progression. This review synthesizes current knowledge on the immunopathogenesis of AA, integrating insights from T-cell mediated autoimmunity, genetic variations, and epigenetic regulation. Advances in diagnostic strategies, including trichoscopy, histopathology, and severity assessment tools, are critically evaluated with attention to their clinical applicability and limitations. Importantly, the therapeutic landscape of AA is rapidly evolving: beyond traditional approaches such as corticosteroids and minoxidil, recent progress in biologics, JAK inhibitors, regenerative strategies including stem cell and exosome-based therapies, nanotechnology, and microneedle-assisted delivery systems is reshaping treatment paradigms. By bridging mechanistic understanding with therapeutic innovation, this review highlights unmet clinical needs, emphasizes opportunities for precision and regenerative medicine, and outlines future directions toward achieving durable and patient-centered outcomes in AA.