**6. Prognosis**

The disease has an unpredictable course; spontaneous regrowth of hair is common as observed in about 80% of patients within one year [25]. However, patients usually present with several episodes of hair loss and hair regrowth during their lifetime [8]. Progression to alopecia totalis and universalis may occur in 5–10% of patients [3].

```
Extent of involvement (alopecia totalis/universalis)
Younger age of onset
Family history
Atopy
Ophiasis
Nail changes
Associated autoimmune disease
```
**Table 1.** Poor prognostic factors.

Some clinical factors that indicate a poor prognosis is defined (**Table 1**). The most important factor is the extent of the disease [1]. The chance of full recovery is less than 10% in alopecia totalis and universalis [12]. Acute diffuse and total alopecia variant constitutes an exception. As discussed earlier in this chapter, these patients have a favorable treatment response despite the substantial hair loss [15]. Other factors reported are young age at disease onset, a positive family history, atopy, ophiasis pattern of loss, nail changes, and associated autoimmune diseases [8, 15]. Positive family history is associated with the early age of onset. In fact, positive family history among first-degree relatives has been reported to be as high as 47% for patients with early onset, in contrast to 1.6% for all patients [6].
