Treatments for Alopecia Areata

While there is no cure for alopecia areata, there are treatments that may regrow hair in both adults and children. The kind of treatment your doctor recommends depends on:

• The type or form of your hair loss
• The severity of hair loss (how much hair you have lost)
• Your age
• What you have tried already
• If you also have an atopic (allergic) condition, such as atopic dermatitis (eczema)

Effective treatments for alopecia areata block the immune system attack on the hair follicles so hair can regrow. Not all treatments work for everyone and finding the right treatment for you can take some time and patience. But there is new hope for people with alopecia areata. Since June 2022, the Federal Drug Administration (FDA) has approved three medications for severe disease, and researchers are studying many other potential treatment options.

Common Treatments for Mild or Limited Alopecia Areata

Some people with mild alopecia areata decide not to have any treatment. Instead, they leave it as is or use different products, such as scarves and hair pieces, or camouflage techniques like hairstyles to hide the affected areas.

However, if you do want to try treatment to stimulate hair regrowth, here are some of the most commonly available treatments:

Topical Corticosteroids

Corticosteroids, or steroids, reduce inflammation around hair follicles, helping hair grow. Corticosteroids are often combined with other treatments for alopecia areata. Topical corticosteroids are a common first choice for children or for adults who can’t have injections (see below).

Intralesional Corticosteroids

The most common treatment for adults with patchy alopecia areata is intralesional injection of corticosteroids  (meaning injection within the bald patch). A very fine needle injects the medication into the areas of missing hair on the scalp or face. Some find the injections painful, while others feel only slight discomfort.  If the injections are successful, you may see new hair growth within six to eight weeks. You can repeat them every four to six weeks, stopping treatment when the hair regrows. If there is no regrowth after six months, your physician will likely stop treatment.

Corticosteroid injections don’t prevent further hair loss. Some people develop temporary depressions or “dents” (called dells) from the injections.

Minoxidil

Oral Minoxidil comes as a tablet in 2.5 mg, 5 mg, or 10 mg strengths. Although some studies have shown that low doses of oral minoxidil on its own have helped hair regrow, it is most often used in combination with other treatments, such as intralesional corticosteroids or JAK inhibitors.  Topical minoxidil is generally not effective on its own for extensive hair loss, however some healthcare providers might prescribe it in combination with other therapies.

Common Treatments for Moderate Alopecia Areata

For patients with moderate disease, treatment for alopecia areata may include topical corticosteroids with or without topical or oral minoxidil. JAK inhibitors may be recommended in some cases of moderate alopecia areata. (See more details on JAK inhibitors in the section on severe alopecia areata, below.) In addition, there are:

Pulse Corticosteroids

Pulse corticosteroids are corticosteroids given at a high dose at regular intervals over a short period of time. The pulsed corticosteroids are typically given by mouth.

Oral steroids cause side effects like weight gain, thinning bones (osteoporosis), rising blood sugar levels, and high blood pressure, among others, and can not be used as a long term treatment. Pulsed steroids appear to have fewer of these side effects.

Topical or Contact Immunotherapy

Topical immunotherapy, also called contact immunotherapy, is generally used to treat more extensive alopecia areata, but may be used for moderate disease as well.

The immunotherapy agent causes an allergic rash (allergic contact dermatitis) where it is applied. This changes your body’s immune response around the hair follicles, though researchers don’t understand why this promotes hair regrowth. The rash can look like poison oak or ivy. The immunotherapy agents most commonly used include squaric acid dibutyl ester (SADBE) or Diphencyprone (DPCP)

There are reports that 40 to 55% of patients experience significant regrowth. If hair regrowth is successful, treatment usually needs to continue to maintain the regrowth. The treatment can be uncomfortable, causing redness and rash where it is applied. Topical immunotherapy is typically performed and prescribed by dermatologists

Duplilumab (Dupixent)

About one-third of people with alopecia areata also have atopic dermatitis or eczema. Dupilumab (Dupixent) is a monoclonal antibody that is FDA-approved for treating atopic dermatitis in adults and children as young as six months. Dermatologists may prescribe dupilumab as the first-line treatment for alopecia areata for people who also have atopic dermatitis or a family history of atopic dermatitis.

Learn more about research studies on dupilumab as a potential treatment for alopecia areata in these webinars:

Webinar

Novel developments in treating alopecia areata: What is Type 2 inflammation and why is it important?

Webinar

The connection between allergies, eczema, and alopecia areata in adults and children: Implications for new treatments

Treatments for Severe Alopecia Areata

JAK Inhibitors

After decades of no new treatments, Janus kinase (JAK) inhibitors have renewed hope for people with moderate to severe alopecia areata.

JAK inhibitors are immunomodulatory drugs. They target the immune system pathway that is overactive in alopecia areata.

Immune cells and hair follicles interact through cellular mechanisms that utilize Janus kinase proteins (or JAKs) to transmit signals in the immune system. By taking a JAK inhibitor, the immune cell attack on the hair follicle is blocked (or inhibited) allowing the normal hair growth cycle to continue and hair to regrow.

JAK inhibitors are considered the first-line treatment for severe alopecia areata, including universalis and totalis. Dermatologists may also use oral minoxidil and/or intralesional injections with a JAK inhibitor.

Three JAK inhibitors are FDA-approved for alopecia areata, but only two are commercially available at this time:

• Baricitinib (Olumiant®, from Lilly), approved for adults 18 and older.
• Ritlecitinib (Litfulo®, from Pfizer), approved for adolescents 12 years old and up (the only JAK inhibitor currently FDA-approved for use in children.)
• Deuruxolitinib (Leqselvi®, from Sun Pharmaceuticals), approved for adults 18 and older, but not yet available due to a patent-infringement lawsuit.

Webinars

Webinar

Expectations of JAK Inhibitor Treatment for Alopecia Areata Treatment

Webinar

Alopecia Areata Treatment Update 2024

Related Content