Treatment for Alopecia Areata
In all forms of alopecia areata, the hair follicles
remain alive and are ready to resume normal hair
production whenever they receive the appropriate
signal. In all cases, hair regrowth may occur even
without treatment and even after many years.
There are no FDA approved treatments specifically
for alopecia areata, alopecia areatatotalis or
alopecia areatauniversalis, however many medical
professionals are willing to try treatments off
Mild, Patchy Alopecia Areata
There are treatment options available for mild,
patchy alopecia areata (less than 50% scalp hair
loss) though there is currently no acceptable
treatment that works in all cases.
The most common treatment is the injection of
cortisone into the bare skin patches. The injections
are usually given by a dermatologist who uses a tiny
needle to give multiple injections into the skin in
and around the bare patches. The injections are
repeated once a month. Both the needle prick and the
slight tingling are usually well tolerated and there
is no discomfort after leaving the doctor’s office.
If new hair growth occurs, it is usually visible
within four weeks. Treatment, however, does not
prevent new patches from developing. There are few
side effects from local cortisone injections.
Occasionally, temporary depressions in the skin
result from the local injections, but these “dells”
usually fill in by themselves.
Five percent topical minoxidil solution applied
twice daily may regrow hair in alopecia areata.
Scalp, eyebrows, and bear may respond. If scalp hair
regrows completely, treatment can be stopped. Two
percent topical minoxidil solution alone is not
effective in alopecia areata; response may improve
if cortisone cream is applied thirty minutes after
the monoxidil. Topical minoxidil is safe, easy to
use, and does not lower blood pressure in persons
with normal blood pressure. Topical minoxidil
solution is not effective in treating those with
100% scalp hair loss.
Anthralin cream or ointment:
Another treatment is the application of anthralin
cream or ointment. Anthralin is a synthetic,
tar-like substance that has been used widely for
psoriasis. Anthralin is applied to the bare patches
once daily and washed off after a short time,
usually thirty to sixty minutes later. If new hair
growth occurs, it is seen in eight to twelve weeks.
Anthralin can be irritating to the skin and can
cause temporary, brownish discoloration f the
treated skin. By using short treatment times, skin
irritation and skin staining are reduced without
decreasing effectiveness. Care must be taken not to
get anthralin in the eyes. Hands must be washed
after applying it.
Alopecia Areata Totalis and Alopecia
Fewer treatment options are available for extensive
alopecia areata (greater than 50% scalp hair loss).
Cortisone pills are sometimes given for extensive
scalp hair loss. Cortisone taken internally is much
stronger than local injections of cortisone into the
skin. It is necessary to discuss possible side
effects of cortisone pills with your physician.
Healthy young adults often tolerate cortisone pills
with few side effects. In general, however,
cortisone pills are used in relatively few patients
with alopecia areata due to health risks from
prolonged use. Also, regrown hair is likely to fall
out when the cortisone pills are stopped.
Another method of treating extensive alopecia areata
or alopecia areatatotalis/universalis is known as
topical immunotherapy and it involves producing and
allergic rash or allergic contact dermatitis.
Chemicals such as diphencyprone (DPCP),
dinitrochlorobenzene (DNCB), or squaric acid dibutyl
ester (SADBE) are applied to the scalp to produce an
allergic rash which resembles poison oak or ivy.
Approximately 40% of patients treated with topical
immunotherapy will regrow scalp hair after about six
months of treatment. Those who do successfully
regrow scalp hair still need to continue the
treatment to maintain the hair regrowth, at least
until the condition turns itself off. An itchy rash
may be uncomfortable in very hot weather, especially
under a wig. These treatments are not available
everywhere in the United States although they are
used frequently in Canada and Europe.
In general, treatments are much less effective for
extensive alopecia areata (particularly alopecia
totalis/universalis). For this reason, an attractive
wig is an important option for some people. Proper
attention will make a quality wig look completely
natural; every wig has to be cut, thinned and
styled, often several times. To keep a net base wig
from falling off, even during active sports, special
double sided tape can be purchased in beauty supply
outlets and fastened to the inside of the wig. For
those with completely bare heads, there are suction
caps to which any wig can be attached and there are
entire suction cap wig units. These state of the art
wigs, which make use of a silicon base to create a
secure vacuum-fit, are comfortable and easily
removed by the wearer. Proper fit of a vacuum wig
requires that any existing scalp hair be shaved.
These wigs are generally more expensive than other
types of wigs.