Alopecia Areata Treatment Options

Alopecia areata (AA) is an autoimmune disorder that can be challenging yet not impossible to treat.

“Although there is no cure for alopecia areata, early detection and diagnosis can lead to treatment interventions that can delay or prevent increased hair loss,” says Michele Green, MD, a New York City–based cosmetic dermatologist who also specializes in alopecia treatment.

Depending on your age as well as the severity of your condition, treatment may involve therapies that help stop the immune system’s attack on your hair follicles, as well as other interventions that may support hair regrowth.

“People with mild disease often respond to corticosteroids, which can be injected directly into the scalp or applied topically,” explains Brittany Craiglow, MD, of Dermatology Physicians of Connecticut and associate adjunct professor of dermatology?at the Yale School of Medicine in New Haven.?“For those with severe or recalcitrant disease, a class of medicines known as Janus kinase (JAK) inhibitors has emerged as a more promising targeted treatment.”

Here’s a look at these AA treatments and others currently available, as well as potential future therapies you may discuss with your dermatologist.

Oral Medications

Oral medications are one of the first treatment methods your dermatologist may consider for treating AA. These may include:

Immunosuppressants?These work by tamping down the immune system’s attack on healthy hair follicles, to help stop further hair loss. The idea here is that if your hair follicles are restored, they may also see hair regrowth. Oral immunosuppressants may come in the form of corticosteroids, such as prednisone, which may also be combined with other immunosuppressants for maximum effect. It may take up to six weeks until you see hair regrowth with oral immunosuppressants, with this treatment option working best for AA hair loss that is either widespread or rapid.

Side effects of immunosuppressants can vary by both individual and the type of medication prescribed. Examples include weight gain, stomach problems, fatigue, and tremors.

JAK Inhibitors?In June 2022, the FDA approved baricitinib (brand name Olumiant), a type of JAK inhibitor, for the treatment of severe AA. To date, this is the first oral medication specifically approved for systemic AA treatment, meaning that it can treat AA-related hair loss experienced in the entire body.

Clinically known as Janus kinase inhibitors, these medications work by blocking certain enzymes that may contribute to inflammatory actions in the body.

?While baricitinib now has official FDA approval, your dermatologist may still prescribe other types of JAK inhibitors on an “off-label” basis, including ruxolitinib or tofacitinib.

Traditionally they’ve been used to treat other autoimmune conditions, such as rheumatoid arthritis, but JAK inhibitors have recently shown promise in treating alopecia, too. JAK inhibitors may treat extensive hair loss related to AA. The downside is that many people have recurring hair loss once they stop taking these medications.

Methotrexate Sold under brand names like Rheumatrex and Trexall, methotrexate is traditionally used to treat severe psoriasis and certain cancers, such as leukemia and lymphoma.

?Your dermatologist may consider methotrexate for AA if you have extensive hair loss and no other treatment has worked.

?Methotrexate itself has immunosuppressant effects, but it may also pose life-threatening risks that you should discuss carefully with a doctor before use.

Topical Treatments

In addition to stopping the immune system’s attack from the inside through oral medications, your doctor may recommend several topical treatments to help stop hair loss and promote hair growth, such as:

Contact or Topical Immunotherapy?This treatment works similarly to oral immunotherapy agents but is applied directly to the skin by a dermatologist. It’s one of the oldest forms of alopecia areata treatment, and an estimated 60 to 70 percent of individuals have hair regrowth after use. It may also be combined with other treatments for maximum effect.

Like other types of immunotherapy, such as allergy shots, contact immunotherapy works by purposely triggering an allergic reaction in your skin. While you may have side effects at first, such as a rash and scaly skin, the hope with this treatment is that your hair will regrow within a few months.

Topical Corticosteroids?As the name suggests, topical steroids are applied directly to your skin. They are safer for long-term use compared with oral steroids, and may be available in a cream, foam, or ointment that you apply to the affected area of hair loss every day. While this treatment option tends to work well in children, it’s not as effective for AA in adults.

Minoxidil (Rogaine)?Available over the counter for pattern hair loss, minoxidil is sometimes recommended to help stimulate hair regrowth in alopecia areata. “Minoxidil works by relaxing the blood vessels making it easier for blood circulation to the scalp,” explains Dr. Green. “The increased blood flow strengthens the hair follicle, promoting hair growth. It also has the benefit of maintaining the hair you currently have.”

Minoxidil is applied to the scalp two to three times daily, and can take a few months to take effect. In some cases, minoxidil may also be applied to the beard and eyebrow areas to help stimulate hair growth.

Anthralin (Drithocreme HP)?Like minoxidil, this is a topical medication that’s applied directly to your scalp. Although traditionally used for psoriasis, anthralin may help treat AA when used in conjunction with minoxidil.

Injections

Some medications used to treat AA are applied topically, but others may be injected into the treatment area by a dermatologist. Injections used in the treatment of AA include injectable corticosteroids.

“Steroid injections to areas where you have experienced hair loss can suppress the immune system cells that are attacking the hair follicles and give your hair time to regrow,” says Green.

Like topical and oral versions, injectable corticosteroids or cortisone may be used to help stop the immune-mediated attacks on the follicles. These may be used in the scalp, as well as other areas of the body. For the best results, you may need to repeat your treatment every four to eight weeks, or as recommended by your dermatologist.

Also, cortisone injections are typically recommended for milder cases of AA, where less than 50 percent of hair has been affected.

Platelet-Rich Plasma (PRP)

Another potential treatment for AA involves PRP, which uses your own blood, separating it in a centrifuge before injecting the plasma into the treatment area.

“PRP has concentrated blood plasma, which contains platelet-derived growth factors and proteins,” says Green. “PRP contains up to 5 times more platelets than normal blood. Restoring the health of the hair follicles can reverse hair loss.”

PRP is not formally approved by the FDA. However, research confirms that PRP may be a safe and effective treatment measure for AA, though there are no specific recommendations to date. Also, this method may work best when combined with other treatments.

Diet and Other Lifestyle Considerations for AA

To date, no particular diet or lifestyle changes are thought to prevent or treat alopecia areata.

“We do not have any strong evidence to support dietary or lifestyle changes for alopecia areata, and unfortunately there are no natural remedies that have been shown to be effective,” Dr. Craiglow confirms.

However, healthy habits overall may help offset some of the triggers and side effects associated with AA. These may include:

A Healthy Diet?There’s no alopecia areata diet per se, but making sure you eat a balanced diet and getting critical nutrients may help promote hair growth as complements to your AA treatments.

?Green also recommends B complex and zinc, which she says may “promote thicker, stronger, and longer hair.”

Research also suggests that these nutrients may help aid AA hair regrowth, along with other micronutrients such as vitamins A and D.

?However, it’s important to discuss any supplements with your doctor before use and to not use these as a replacement for other AA treatments.

Stress Management?Stress alone isn’t a cause of AA, but it may trigger this autoimmune disease. Also, the effects of AA can leave you feeling more stressed, leading to a cycle. Try to manage this stress as best as you can by making time each day for relaxing activities, such as meditation, deep breathing, or yoga.

Protecting Your Skin?It’s also important to protect any areas of bare skin you have from the sun and other environmental elements. For example, a hat or scarf can protect your scalp from UV rays, and sunglasses can help protect your eyes if AA has affected your eyelashes. You should also apply sunscreen daily. Your doctor may also recommend taking measures to protect your nose from germs in the case of nasal hair loss.

?Examples include over the counter emollients, such as Aquaphor,

?and, in some cases, prescription antibiotic ointments such as mupirocin (Bactroban).

Finally, it’s important to have regular checkups with your doctor. Since autoimmune diseases tend to run in multiples, there’s a chance that having alopecia areata could increase your risk for developing another immune-mediated disease. Regular physicals and blood testing can help your doctor diagnose such conditions as early as possible for prompt treatment.

Summary

When treating alopecia areata, the primary goal is to promote hair regrowth. This may be done by using medications to stop the immune system’s attack on hair follicles, along with other therapies that may stimulate regrowth more generally.

The earlier you seek treatment, the better the chances of hair regrowth at some point in your AA journey. “Getting treatment for hair loss in its early stages can help minimize overall hair loss and increase treatment efficacy,” says Green.

Craiglow also stresses the importance of early treatment. “For people who have not had hair for more than 7 to 10 years, the chance of regrowth, even with targeted therapies like JAK inhibitors, starts to decrease somewhat,” she explains.

The unpredictable nature of AA can be frustrating, but it’s important to be as patient with your treatment plan as you can. Not only can it take time and a bit of trial and error before finding a treatment method that works, it’s also important to know that not every type works the same for everyone.

Mohiba Tareen, MD

Medical Reviewer

Mohiba Tareen, MD, is a nationally acclaimed board-certified dermatologist. She practices medical, surgical, and cosmetic dermatology at her Minnesota medical practice, Tareen Dermatology. Dr. Tareen takes joy in providing comprehensive dermatologic care to the entire family — from acne, to skin cancer, hair loss, and anti-aging, she provides her expertise to patients at all stages of their lives. Cosmetically, Tareen believes in subtle and natural aesthetic enhancements.

Personally, she is proud of her husband, a fellow caring physician, and her active brood of five children.

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Kristeen Cherney, PhD

Author

Kristeen Cherney, PhD, is a freelance writer, essayist, author, and poet with more than 15 years of health writing experience for digital platforms such as Healthline, The Mighty, and LiveStrong. She’s covered nutrition, women’s and children’s wellness issues, as well as specialized topics ranging from diabetes and thyroid disease to anxiety, depression, asthma, allergies, and skin conditions.

With a doctorate in English (rhetoric and composition), Dr. Cherney focuses her academic scholarship on the intersection between disability and literacy. She also holds a Master of Arts in English and a Bachelor of Arts in communication.

Cherney has contributed to the books The Wiley Handbook on Violence in Education: Forms, Factors, and Preventions, Composing in Four Acts: Readings for Writers, and Georgia State University's Guide to First-Year Writing, as well as to?scholarly journals like Praxis, the Journal of Teaching Writing, and the Journal of Dracula Studies.

Cherney enjoys running, meditating, hiking, and paddleboarding.

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Resources

Alopecia Areata: Diagnosis, Treatment, and Steps to Take. National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Hair Loss Types: Alopecia Areata Diagnosis and Treatment. American Academy of Dermatology Association.
Immunosuppressants. Cleveland Clinic.
FDA Approves First Systemic Treatment for Alopecia Areata. U.S. Food and Drug Administration.
Methotrexate. MedlinePlus.
Alopecia Areata. American Academy of Family Physicians.
Alopecia Areata. National Organization for Rare Disorders.
Platelet-Rich Plasma in the Treatment of Alopecia Areata: A Review. Journal of Investigative Dermatology Symposium Proceedings.
Alopecia Areata. Cleveland Clinic.
Combined Diet and Supplementation Therapy Resolves Alopecia Areata in a Pediatric Patient: A Case Study. Cureus.
Hair Loss Types: Alopecia Areata Self-Care. American Academy of Dermatology Association.
Nose Woes: Avoiding Winter’s Nasal Problems. UVA Health.
Mupirocin Nasal Ointment. Egton Medical Information Systems.

Additional Sources

Alopecia Areata: Diagnosis, Treatment, and Steps to Take. National Institute of Arthritis and Musculoskeletal and Skin Diseases. April 2021.
Hair Loss Types: Alopecia Areata Diagnosis and Treatment. American Academy of Dermatology Association.
Hair Loss Types: Alopecia Areata Self-Care. American Academy of Dermatology Association.
FDA Approves First Systemic Treatment for Alopecia Areata. U.S. Food and Drug Administration. June 13, 2022.
Methotrexate.?MedlinePlus. April 15, 2017.
Alopecia Areata. American Academy of Family Physicians. July 2, 2021.
Alopecia Areata. National Organization for Rare Disorders.
Alopecia Areata. Cleveland Clinic. April 3, 2018.
Immunosupressants.?Cleveland Clinic. March 17, 2021.
Almohanna HM, Ahmed AA, Griggs JW, et al. Platelet-Rich Plasma in the Treatment of Alopecia Areata: A Review. Journal of Investigative Dermatology Symposium Proceedings. November 2020.
Harvey CJ. Combined Diet and Supplementation Therapy Resolves Alopecia Areata in a Pediatric Patient: A Case Study. Cureus. November 2020.
Nose Woes: Avoiding Winter’s Nasal Problems. UVA Health. October 16, 2016.
Mupirocin Nasal Ointment. Egton Medical Information Systems. February 7, 2022.