Treatments
Although a cure for alopecia has yet to be determined or a treatment that has proven to be successful for all forms of the disease, there are treatments that have been effective for some people. Depending on your age and the type and severity of your prognosis, there are various options that may work. Please consult with a doctor or medical professional for the best treatment option(s) for your unique journey1.
Below, we’ve provided a list of treatments that you may encounter through research or in discussion with a medical professional. The main goals of treatment are to block the immune system attack and/or stimulate the regrowth of hair1.
Please note that Betty D's is not taking ownership of this list and it is not an extensive review of all possible treatments. The treatments below serve as an overview of the common treatments you are likely to encounter or discuss with a medical professional, as originally published by the National Alopecia Areata Foundation.
Treatments for Mild Alopecia
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 dermatologist1.
Benefits
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 treatment1.
Drawbacks
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 office1.
Topical Minoxidil
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 results1.
Benefits
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 effects1.
Drawbacks
Topical minoxidil is not considered effective on its own in treating patients with extensive hair loss1.
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 hours1.
Benefits
If new hair growth from anthralin application happens, it is usually visible within eight to 12 weeks1.
Drawbacks
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, without decreasing the treatment’s effectiveness1.
Topical Corticosteroids
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 ointments1.
Benefits
Studies have shown that there is a reduction in 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 areata1.
Drawbacks
The effectiveness of topical corticosteroids is limited by their absorption in the scalp1.
Treatments for Extensive Alopecia Areata, Alopecia Totalis, and Alopecia Universalis
Oral Corticosteroids
Corticosteroids taken in the form of a pill are sometimes prescribed for extensive scalp hair loss to try to suppress disease activity and regrow hair1.
Benefits
Some patients may experience hair regrowth during the short period they can tolerate using this medication1.
Drawbacks
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 stopped1.
Topical Immunotherapy
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 response1.
Benefits
Approximately 40% of patients treated with topical immunotherapy will regrow scalp hair after about six months of treatment1.
Drawbacks
Patients who successfully regrow scalp hair usually must continue treatment 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.1
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 oral medication. A topical formulation is currently in clinical trials in the United States1.
Benefits
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 far1.
Drawbacks
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 to evaluate the oral and topical medication’s effectiveness and safety in treating alopecia areata1.
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 profile1.
Betty D's cannot and does not contain