We have demonstrated that serum macrophage migration inhibitory factor (MIF) was significantly elevated in patients with extensive alopecia areata (AA). Recently, functional polymorphisms have been identified in the MIF promoter region. To address the functional and prognostic relevance of the À173G/C and À794[CATT] 5-8 repeat polymorphisms in MIF genes in patients with extensive AA, 113 patients with extensive AA and 194 healthy controls were genotyped. We found that MIFÀ173*C was a risk factor for early onset (o20 years) of extensive AA (odds ratio for GC heterozygotes with À173G/C was 4.88 (95% CI, 2.04-11.8), P ¼ 0.00038; odds ratio for CC homozygotes with À173G/C was 10.42 (95% CI, 2.56-43.5), P ¼ 0.0011). We found no statistically significant differences in the genotype frequencies of the À794[CATT] 5-8 repeat polymorphism and extensive AA. These results suggest that polymorphisms within the MIFÀ173*C allele confer an increased risk of susceptibility to the extensive forms of AA, especially with an early onset of disease. MIF is therefore suggested to be closely implicated in the pathogenesis of the more extensive forms of AA.