Background: Alopecia areata (AA) is a chronic, immune-mediated, non-scarring hair loss disorder with a wide range of clinical symptoms and etiological associations. Assessing the etiological causes, therapeutic outcomes, and clinical patterns of individuals with alopecia areata in Western Uttar Pradesh was the aim of this study.

Methods: 102 patients with alopecia areata were the subjects of a cross-sectional clinico-etiological investigation. Comprehensive laboratory, clinical, and demographic information was gathered, including endocrine and immunological profiles. The severity of the condition was used to assess treatment responses.

Results: The majority of patients were between the ages of 21 and 30 (mean: 22 ± 9.61 years), urban (61.8%), and unmarried (64.7%). The condition lasted an average of 11 months, with an average beginning age of 21 years. With 34.3% of cases displaying a single lesion and 42.2% displaying multiple lesions, the scalp was the most frequently affected area. In addition to exclamation mark hair (24.5%) and nail abnormalities (19.5%), systemic correlations were noted, including thyroid dysfunction (8.8%) and hypothyroidism (16.6%). Immunoglobulin levels were decreased (p < 0.05). Steroid pulse + azathioprine generated the best results in severe cases (64.2%), while ILS + tacrolimus produced the best results in localised instances (66.6%).

Conclusion: Alopecia areata mainly affects young individuals in this area, and it manifests in a range of clinical patterns and systemic links, especially with thyroid problems and immunological imbalance. Early identification and tailored treatment strategies are essential, especially for severe and resistant variants.