BACKGROUND: Alopecia areata (AA) is a common autoimmune non-scarring type of hair loss characterized by round patches on the scalp or body. AA is the second most common form of hair loss after male-pattern baldness in men, and female-pattern baldness in women. AIM OF THE STUDY: This study aims to examine the correlation between trichoscopic patterns and AA severity, evaluated by the Severity of Alopecia Tool (SALT) score, and to analyze the impact of demographic and clinical factors on treatment outcomes. PATIENTS AND METHODS: A prospective cross-sectional single-center study was conducted involving 303 patients with AA, assessing the relationships between trichoscopic findings, clinical features, treatment responses, and SALT scores. RESULTS: Our cohort comprised 50.83% females and 49.17% males, ranging in age from 6 months to 84 years, with a mean age of 23.67 ± 14.79 years and an average disease onset at 21.68 (± 14.30) years. Localized and Multiple patchy AA were the most observed subtypes, with ophiasis, alopecia universalis, and totalis being less frequent. Small vellus hairs, exclamation mark hair, and coudability hair emerged as prevalent trichoscopic findings. A significant prevalence of comorbidities (82.18%) was observed, particularly micronutrient deficiencies, autoimmune and endocrine disorders, and atopic diseases. Key predictors of more severe AA, as indicated by higher SALT scores, include prolonged disease duration, nail involvement, and neuropsychiatric comorbidities. Shorter disease duration was correlated with active disease markers such as broken hairs, black dots, yellow dots, and exclamation mark hair. Markers like cumulus-like white dots and v-sign correlated with severe disease stages, whereas pigtail hairs, small vellus hairs, and upright regrowing hairs indicated new hair growth or positive treatment responses. CONCLUSION: Trichoscopy proves crucial for assessing AA severity and treatment efficacy, facilitating personalized treatment approaches and improving patient management outcomes.