It is likely that alopecia areata is a multifactorial disease determin
ed by a combination of genetic and environmental factors. The interact
ion of susceptibility genes with environmental factors gives rise to t
he disease phenotype, and then genetic modifying factors determine the
extent of the inflammatory response and thereby the clinical outcome.
Cytokines regulate the inflammatory response. Polymorphisms in these
genes may therefore determine the amount of a cytokine that is produce
d in response to an environmental trigger such as a bacterial or viral
infection.