How Alopecia Areata Is Treated

Though the hair loss that results from alopecia areata is due to a malfunctioning immune system—in this case, one that attacks hair follicles—there is no medical need to treat it. Alopecia areata is not contagious, painful, or dangerous. (However, there is an association between alopecia areata and autoimmune disease, so experts screening tests.)

No treatment can permanently change the course of this skin disorder or cure it. Still, some people with alopecia areata seek medications, therapies, and other solutions to help manage it and regrow hair.

In this article, you'll learn about the treatment options for alopecia areata, including prescription and over-the-counter medications, complementary and experimental therapies, and self-care/cosmetic approaches.

Prescriptions

Although there is only one treatment for alopecia areata approved by the U.S. Food and Drug Administration (FDA), various prescription medications have been scientifically shown to help regrow hair.

Janus Kinase (JAK) Inhibitors

JAK inhibitors, which include Olumiant (baricitinib), Xeljanz (tofacitinib), and Rinvoq (upadacitinib), blunt inflammation by blocking signaling pathways during the immune response. At present, these drugs are FDA approved to treat rheumatoid arthritis.

In June 2022, the FDA approved Olumiant for the treatment of adults with severe alopecia areata. It is taken by mouth and is the first systemic treatment approved for alopecia areata.

There are serious possible side effects associated with JAK inhibitors, such as heart-related events, infection, cancer, blood clots, and even death.

Corticosteroids

Corticosteroids, also known as steroids, are commonly used to treat alopecia areata. They block the immune system's attack on hair follicles.

These drugs can be injected into the skin with a needle, applied to the skin (topical), or taken by mouth (oral).

Injected Corticosteroids

A dermatologist may inject corticosteroids directly into the areas on the skin where there is no hair or the hair is thinning.

This office-based procedure is used to treat patients with patchy, relatively stable hair loss. It is not for patients with extensive hair loss, like someone who is mostly bald.

Injected steroids have been found to be quite effective, although results are not immediate.

Injections are generally given every one to two months. To minimize any discomfort from the needle stick, your dermatologist may apply a numbing cream to the skin prior to the injection.

Topical Corticosteroids

Topical corticosteroids come in different strengths and preparations, such as solutions, creams, lotion, foams, ointments, and shampoos.

They are often applied daily to the area of hair loss and used for patients with patchy alopecia areata who cannot tolerate injected corticosteroids.

Oral Corticosteroids 

Oral corticosteroids, like prednisone, are sometimes prescribed for a short period of time for patients with extensive and/or rapid hair loss.

Prolonged corticosteroid use is not advised due to the risk of serious, sometimes irreversible, side effects.

Topical Immunotherapy

Topical immunotherapy is sometimes used to treat extensive cases of alopecia areata. With this, a dermatologist applies a chemical—like diphencyprone (DPCP) or squaric acid dibutyl ester (SADBE)—to the scalp once a week to trigger hair regrowth.

These chemicals essentially create a mild allergic rash on the skin which is believed to alter a person's immune response to the hair follicles. Redness and itching at the site of application are common.

Hair regrowth is expected to occur within three to six months of beginning treatment, but it can take up to 12 months. Treatment is continued every week until the hair is re-grown.

Once the hair is re-grown and the treatment is stopped, patients are monitored for a recurrence of hair loss. If that occurs, patients may benefit from re-starting therapy.

For some patients, continuing topical immunotherapy may be recommended to maintain hair regrowth.

Anthralin

Anthralin is a tar-like substance available as a cream or ointment. It was one of the first medications used for psoriasis.

For alopecia areata, it is applied daily to hairless patches, left on for around 30 minutes, and then washed off. Hair regrowth may occur within two to three months of beginning treatment.

The downsides to anthralin are that it's not always effective, can stain fabric, and can cause your skin to itch and/or become discolored.

Other Immunosuppressants

Other drugs that weaken the immune system are occasionally used to treat extensive and/or rapidly worsening alopecia areata.

Methotrexate or cyclosporine are two examples.

Over-the-Counter Medications

Rogaine, which is minoxidil that gets applied to the skin, works by both improving blood flow to the hair follicles and increasing their growth phase.

It is available over the counter in a solution or foam formulation, and is usually applied to the scalp twice daily.

Rogaine is only effective in people with early or patchy hair loss, and it takes up to six months to see results.

On the plus side, Rogaine has minimal side effects and may be combined with topical steroids for improved outcomes.

Complementary and Alternative Medicine (CAM)

Most studies examining the benefit of CAM therapies for alopecia areata are, unfortunately, not well-designed or reveal conflicting results.

It's still reasonable, though, to consider trying out a CAM treatment option with your healthcare provider's OK.

While not a complete list, here are some CAM remedies that have at least some scientific evidence, albeit limited, for hair regrowth in alopecia areata.

Essential Oil Aromatherapy

In one study, participants with alopecia areata were taught by a trained aromatherapist to perform nightly scalp massages using one of two combinations of oils:

• The treatment group received an essential oil blend of thyme, rosemary, lavender, and cedarwood in a mixture of carrier oils (jojoba and grapeseed).
• The control group only received the carrier oils (jojoba and grapeseed).

Photographs of the participants' scalps were taken at the start of the study and after three and seven months of treatment. The photographs were assessed for hair growth and scored by two dermatologists.

Results revealed that those who underwent the essential oil aromatherapy massages had a meaningful improvement in hair growth compared to the control group.

The relative lack of improvement in hair growth in the control group suggests that simply massaging the scalp is not useful for treating alopecia areata.

Garlic Extract

Garlic extract may promote hair growth by tamping down inflammation and altering how a person's immune system works.

One study found that combining a garlic-containing gel with topical steroids was more beneficial in treating alopecia areata than using topical steroids alone.

Peony Capsules and Glycyrrhizin Tablets

Extracts from the root of the Peony plant and the licorice plant are traditional Chinese medical therapies that have been found to improve mild and moderate alopecia areata in adults and severe alopecia areata in children.

These plant extracts—specifically compound glycyrrhizin tablets (CGT) and total glucosides of peony capsules (TGPC)—are believed to prevent hair loss by reducing inflammation and suppressing a person's immune system response.

Hypnosis

Since hair loss in alopecia areata may be triggered by stress, undergoing hypnosis to help reduce stress is considered by some experts to be a reasonable complementary therapy.

During hypnosis, a trained mental health professional or therapist guides you into a trance-like state of consciousness. As a result, you have a heightened ability to concentrate and are more responsive to therapeutic suggestions.

While there is some scientific evidence that hypnosis may have some benefit in treating alopecia areata, it looks like this therapy is more useful for reducing anxiety and depression than regrowing hair.

That said, hypnosis is considered safe for most people, so you might consider giving it a try.

Acupuncture

In an animal study published in Acupuncture in Medicine in 2013, tests on mice demonstrated that electroacupuncture may inhibit certain alopecia-related changes in skin cells.

Electroacupuncture is a form of acupuncture in which needles are attached to a device that produces continuous electric impulses. The needles are then placed at specific points on the patient's body.

It's unclear exactly how this therapy could help hair loss, but it may be related to improved blood flow. Studies on humans are needed to determine its true benefit.

Experimental Treatments

As researchers learn more about alopecia areata, there are a couple of treatment options being explored.

Excimer Laser

The excimer laser delivers a highly energetic beam of ultraviolet (UV) light directly onto the area of hair loss.

This procedure is generally performed twice a week for a maximum of six months. It's believed to work by destroying the immune system cells that are attacking the hair follicles.

Excimer laser therapy for patchy alopecia areata appears safe, even in children. However, more investigation is needed to better understand its long-term effects and how it compares to standard therapies.

Platelet-Rich Plasma

Platelet-rich plasma (PRP) is a 30-minute procedure that is done in a doctor's office. It involves a doctor drawing a small amount of blood, and then spinning the blood in a machine that separates it into parts.

The goal of this is to pull out plasma, the part of the blood that's rich in platelets (cell fragments that help your blood clot) and growth factors (substances that increase cell growth and survival).

The doctor then takes that plasma and injects it into areas of the body with hair loss.

PRP needs to be repeated—generally once a month for three months initially, and once every three to six months thereafter.

While more investigation is needed, early research suggests it's a safe and effective treatment option for alopecia areata.

Self-Care & Cosmetic Approaches

Whether or not you are undergoing active treatment for your hair loss, you should still adopt certain self-care strategies to protect your skin.

For instance, your dermatologist may recommend the following:

• Wear a hat or sunscreen on your scalp if your hair loss is extensive.
• Apply an antibiotic ointment inside each nostril if you have lost your nose hairs.
• Wear glasses to protect your eyes if you have lost your eyelashes.

You may also consider the following cosmetic approaches:

• Wearing a wig or hairpiece, including one that is custom-made.
• Wearing a spray or powder scalp concealer to hide your hair loss.
• Wearing false eyelashes.
• Tattooing on eyebrows or applying stick-on eyebrows.
• Shaving your head or beard to hide hair loss.

If your self-image or self-esteem has been impacted by alopecia areata, you may find that opting for ways to make your hair look more abundant or to hide the amount of loss you've experienced are worthwhile.

But remember that you always have the option to embrace your new look. Not only does it offer the practical benefits of being easier and less expensive, but it may just open up the opportunity for you to educate someone curious about alopecia areata.

Do what you feel is best and makes you feel most like yourself.

Summary

Alopecia areata is an autoimmune disease that causes a person's hair to fall out. While treatment is not medically necessary, many people consider it due to how the disorder can affect self-image and self-esteem.

If you decide to pursue treatment, there are a number of options available, depending on your preference and the severity of your disease.

Common therapies include injecting or applying corticosteroids to the areas of hair loss and/or using Rogaine. Complementary therapies and cosmetic approaches to cover up hair loss may also be tried.

A Word From Verywell

Alopecia areata, while harmless, can be a frustrating disease. Even if you do not want treatment, seeing a dermatologist can help you feel supported and help you gain knowledge, especially since each case is unique.

It's also important to not underestimate the emotional toll hair loss can have on your life. If you are feeling anxious or depressed, be sure to reach out to a primary care physician, dermatologist, or therapist for guidance. You may also consider joining a support group through a professional organization like the National Alopecia Areata Foundation.