Abstract
Background. Alopecia areata (AA) is a common autoimmune disease that significantly impacts patients' quality of life due to sudden hair loss and the potential development of severe forms of the disease. The lack of universally effective treatment creates a substantial unmet medical need. The growing body of research on the role of the immune system, genetic factors, and gut microbiota in the pathogenesis of AA opens new prospects for the development of targeted therapeutic approaches. Aim: to examine the complex mechanisms of alopecia areata pathogenesis, including autoimmune processes, the influence of genetic and environmental factors, and potential promising treatment directions. Materials and methods. Data from genetic studies, clinical observations, and experimental models were used. The results of molecular-biological and immunological studies related to immune tolerance mechanisms, the role of gut microbiota, and its associations with other autoimmune diseases were analyzed. Results. AA is associated with a significant disruption of immune tolerance, leading to an autoimmune attack on the hair follicle. Genetic links to other diseases support the hypothesis of shared mechanisms of development. The role of gut microbiota in immune response formation and modulation of inflammatory processes is demonstrated at both experimental and clinical research levels. Conclusion. Studies on the pathogenesis of AA highlight the need for further research to develop effective therapeutic strategies aimed at restoring immune tolerance and regulating gut microbiota. Personalized treatment approaches may improve outcomes in AA patients, promoting long-term remission and enhancing quality of life