Treatments for Alopecia Areata
What you need to know about treatments for alopecia areata
Although there are currently no treatments that work for everyone with alopecia areata, some treatments are effective for some people. Depending on which type of alopecia areata you have, your age and the extent of hair loss, there are a variety of treatment options available. The main goals of treatment are to block the immune system attack and/or stimulate the regrowth of hair. This can be effective, especially for people with milder forms of the disease (less than 50% hair loss).
For those who have more than 50% hair loss on their scalp or other areas of the body, there are also oral (taken as a pill) and topical (applied to the skin) medications available as well as phototherapy or light treatments.
While none of the medications or devices commonly used to treat alopecia areata are approved specifically for this disease by the Food and Drug Administration (FDA), they have been approved for other diseases. It’s important to know that while these therapies may offer benefits to some people with alopecia areata, there is no single option that will work for everyone. Even if your hair is regrown, there is no guarantee that it won’t fall out again once treatment is stopped.
This is not an extensive review of all possible treatments, just an overview of the more common ones you are likely to encounter. It’s best to discuss all of your options for treatment with a dermatologist, who can work with you to find the right medications or therapies for your particular type and severity of alopecia areata.
If there is no cure for alopecia areata, what good are treatments?
There are a variety of treatments for both mild and severe alopecia areata — it’s important to stay informed, so you and your doctor can choose the best course for yours. Goals of therapy include stopping active hair loss and regrowing hair.
Learn more about your options and the challenges for treatment, whether you have just a few patches or more extensive hairloss
Get the latest alopecia areata news and research, so you can stay at the forefront of advancements in treatment
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Treatments for mild alopecia areata
INTRALESIONAL CORTICOSTEROID INJECTIONS
This method of treatment — the most common form of treatment for alopecia areata — uses corticosteroids that are injected into bare patches of skin with a tiny needle. These injections are repeated about every four to six weeks and are usually given by a dermatologist.
If new hair growth occurs from corticosteroid injections it is usually visible within four weeks. There are few known side effects related to this kind of treatment.
Corticosteroid injections, like all treatments for alopecia areata, do not prevent new hair loss from developing. While there are few reported side effects related to this kind of treatment, temporary depressions (called “dells”) in the skin may result from the injections. However, these usually improve with time. People may experience slight discomfort from the needle pricks and tingling from the medication, but usually there is no other pain or discomfort after leaving the dermatologist’s office.
With this form of treatment, a 5% topical minoxidil solution is applied once or twice a day to help stimulate hair on the scalp, eyebrows and beard to regrow. Two and 5% topical minoxidil solutions are available but aren’t usually effective for alopecia areata when used alone, but when applied in combination with topical corticosteroid medications, some people see improved results.
If a person’s hair grows back completely with topical minoxidil, treatment can be stopped. This medication is considered easy to use and has minimal side effects.
Topical minoxidil is not considered effective on its own in treating patients with extensive hair loss.
ANTHRALIN CREAM OR OINTMENT
This synthetic, tar-like substance — also widely used for psoriasis — is a common form of treatment for alopecia areata. Anthralin is applied to the hairless patches once a day and then washed off typically after a short time (usually 30-60 minutes later) or in some cases, after several hours.
If new hair growth from anthralin application happens, it is usually visible within eight to 12 weeks.
This form of medication may irritate the skin and cause a temporary, brownish discoloration of the skin that’s been treated. However, some patients can reduce these side effects by using anthralin for shorter periods of time, without decreasing the treatment’s effectiveness.
In alopecia areata, corticosteroids are thought to decrease the inflammation around the hair follicle. Topical steroids can come in different brands, strengths and preparations, such as solutions, lotions, foams, creams, or ointments.
Studies have shown that there is a reduction of hair loss when using topical steroids. In addition, improved regrowth of approximately 25% has been observed with the use of highly potent topical corticosteroids. They can be good adjunct medications especially when treating children with alopecia areata.
The effectiveness of topical corticosteroids is limited by their absorption in the scalp.
Alopecia areata products and accessories that make a dfference
There are many therapies which can offer benefits for someone with alopecia areata, however there is no single option proven to work for everyone. Some people with alopecia areata may choose accessories, wigs, or cosmetic alternatives to address their hair loss, while others opt not to cover affected areas.
Treatments for extensive alopecia areata, alopecia totalis and alopecia universalis
Corticosteroids taken in the form of a pill are sometimes prescribed for extensive scalp hair loss to try to suppress disease activity and regrow hair.
Some patients may experience hair regrowth during the short period of time they are able to tolerate using this medication.
Healthy, young adults can usually tolerate corticosteroid pills with few side effects. However, doctors do not prescribe corticosteroid pills as often as other treatments for alopecia areata, because of the health risks and side effects associated with using them for a long period of time. It’s important to talk to your doctor about your goals for treatment and possible side effects of the medication, to be sure the benefits of using corticosteroid pills in your case are greater than the risks. As with other options, hair regrown with corticosteroid use may fall back out once treatment is stopped.
Topical immunotherapy is used to treat extensive alopecia areata, alopecia totalis and alopecia universalis. This form of treatment involves applying chemicals such as diphencyprone (DPCP), dinitrochlorobenzene (DNCB) or squaric acid dibutyl ester (SADBE) to the scalp. This causes an allergic rash (allergic contact dermatitis) that looks like poison oak or ivy, which alters the immune response.
Approximately 40% of patients treated with topical immunotherapy will regrow scalp hair after about six months of treatment.
Patients who successfully regrow scalp hair usually must continue treatment in order to maintain the regrowth. Side effects — redness, itching and a rash at the site of application — are common. Topical immunotherapy isn’t widely available and is typically performed and prescribed by dermatologists. The National Alopecia Areata Foundation can help you find a specialist who offers this treatment in the U.S.
IMMUNOMODULATORS: DRUGS TO BLOCK THE IMMUNE RESPONSE
Immunomodulatory drugs — specifically, Janus kinase (JAK) inhibitors — such as tofacitinib (Xeljanz) and ruxolitinib (Jakafi), are a new type of therapy being tested for alopecia areata. These medications were originally approved to treat certain blood disorders and rheumatoid arthritis. They are not approved by the FDA for alopecia areata yet, and are only available right now in the form of an oral medication. A topical formulation is currently in clinical trials in the United States.
Oral immunomodulators have proven to be effective at helping some patients with extensive alopecia areata regrow hair — even if they’ve had the disease (and hair loss) for many years. This has been observed in the small number of patients studied so far.
Because this is a new form of therapy, there isn’t a lot of information known about the side effects of taking this medication. Clinical trials are being done in order to evaluate the oral and topical medication’s effectiveness and safety in treating alopecia areata.
Treatment algorithm for the management of alopecia areata
Patients with alopecia areata, alopecia totalis and alopecia universalis can be treated based on age and severity of the condition. This algorithm outlines an approach that can be used from mild to severe forms of the disorder. There are now choices that the patient can decide on what is best for them based on efficacy, cost and side effect profile.
Copyright © 2017 American Academy of Dermatology, Inc.
Reprinted from Strazzulla et al., 2018 with permission from Elsevier.