Treating Alopecia Areata

Je Alopecia areata is an autoimmune disease that causes the hair to fall out. For many people with alopecia areata, it's possible to regrow hair. Some may regrow hair spontaneously, and others may have cycles of hair loss and regrowth. When your hair doesn't grow back on its own, there are treatment options that may help. 1,2

Treatment Goals

The main goals of treatment are to stop your immune system from attacking the hair follicles and to stimulate your hair to regrow. Which treatments are right for you may depend on: 2,3

Your age
The amount of hair loss you have
The location of your hair loss (including eyebrows and eyelashes)

Types of Treatments

There are a variety of treatments for alopecia areata. Your dermatologist may recommend one or more treatments for you. No treatment works for everyone so it's important to work with your dermatologist to create a treatment plan that's best for you. 3

Corticosteroid (steroid) shots: Steroid shots work to decrease inflammation around the hair follicles. Steroids are used to treat patients with patchy alopecia areata and can also be used along with other medicines to treat widespread hair loss. 4,5

Topical treatments: Topicals are applied directly to bald spots on the scalp, the beard area, and the eyebrows. Some you can buy over-the-counter, while others need to be prescribed by a doctor. 3

Topicals work in different ways:

Steroids. These medicines are similar to steroid shots, and they can be used alone or with other treatments. They can be applied at home. For children 10 years and younger, topical steroids can be effective when used alone and they may be preferred over shots. 3,5

Minoxidil. This medicine is available over-the-counter. It can be used to help you keep hair growth that was stimulated by other treatments. When used alone it doesn't work as well. Since this medicine has few side effects, it's often recommended for children. 3,5

Topical immunotherapy. This treatment works to reset your immune system, so it stops attacking your hair follicles. It involves applying a chemical to bald skin which irritates the skin and causes rash, redness, swelling, and itch which leads to hair regrowth. This treatment has been shown to work for many people with severe alopecia areata, even for kids 10 years of age and older. It's applied in a doctor's office. 3,5,6

Oral steroids. This medicine has been shown to help hair regrow for those with widespread hair loss. However, because of possible serious side effects it can't be taken for a long time. 3,5

Methotrexate. This treatment may be an option if you have widespread hair loss and other treatments haven't worked. It can be used alone or combined with a steroid. 3,5

Janus kinase (JAK) inhibitors. JAK inhibitors are a newer type of medicine used to treat a number of diseases. They have now been shown to be useful in treating alopecia areata, even in some patients when nothing else works. However, when you stop taking the medicine hair often falls out again. 2,3,5

When You Choose to Cover Up Hair Loss

Some people with alopecia areata decide against treatment and instead choose to cover up their hair loss. Others hide their hair loss while they wait for treatment to work. If you prefer to cover up your hair loss, there are a variety of things you can do.

Scalp. There are a number of options for hair loss on the scalp. 2,3,5

Wigs and hairpieces. These can help cover up hair loss permanently or during treatment. You might also choose to get a custom-made wig that has a more perfect fit, known as a scalp prothesis
Semipermanent hair additions. Hair additions are bonded, glued, or sewed to your existing hairs to help hide the appearance of hair loss
Hats, bandanas, and scarves can be used to accessorize and cover hair loss
Shaving. You might choose to shave your head or beard if you have patchy hair loss

Eyebrows and eyelashes. If you've lost hair from your eyelashes or eyebrows, you could try wearing false eyelashes or applying stick-on eyebrows. You also could try makeup or tattoos to disguise loss of eyebrow hair.

Note: If you're interested in a wig or scalp prothesis, you may need a prescription. Ask your doctor's office if they'll work with your insurance company to determine what kind of coverage you have for treatments and wigs for alopecia areata. 7

Care for Yourself

Cover your scalp when going outdoors. Apply sunscreen or wear a hat to protect your scalp from the sun. Choose a sunscreen that is SPF 30 or higher and water resistant. When it's cold, keep warm with hats and scarves. If you've lost hair in your nose or ears, they can be covered up too. 8
Protect your eyes. Eyebrows and eyelashes are more than just facial features, they also help protect your eyes and vision. If you've lost your eyebrows or eyelashes, wear false eyelashes and stick-on eyebrows to help protect your eyes. Eyeglasses or sunglasses can help keep sun and dust out of your eyes. 2,8
Reduce stress. Some people with alopecia areata report feeling stressed out before they go through a cycle of hair loss. If stress is bothering you, find ways to reduce it. You could try yoga, meditation, and physical activity. 8
See your doctor(s) when recommended. Don't skip visits with your dermatologist. Also see your primary care doctor or other health care provider when advised. When you have alopecia areata, you're at higher risk of getting thyroid disease and other autoimmune diseases. The earlier you get diagnosed, the easier they are to manage. 2,8

Get Support

In general, alopecia areata doesn't affect your physical health, but hair loss can be a deeply personal experience and it may be hard to talk about it with others. Here are some things you can do to help manage the disease's impact on your everyday life. 2,8,9

Learn about alopecia areata and the different types of treatments and their side effects. You may decide you don't want treatment. Talk with your family, friends, dermatologist, pharmacist, and others with alopecia areata.
Millions of people have the disease, and many share your feelings and understand how you feel. Connect with others who have alopecia areata. Consider joining a support group for people with alopecia areata.
If hair loss has you feeling sad, anxious, or depressed seek help from a mental health professional. Talk to your family about how you feel.

Get more information and support from the National Alopecia Areata Foundation at naaf.org

References

American Academy of Dermatology. Hair loss types: alopecia areata causes. Accessed July 19, 2023. https://www.aad.org/public/diseases/hair-loss/causes
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Alopecia areata. Reviewed April 2021. Accessed July 19, 2023. https://www.niams.nih.gov/health-topics/alopecia-areata
American Academy of Dermatology. Hair loss types: alopecia areata diagnosis and treatment. Accessed July 20, 2023. https://www.aad.org/public/diseases/hair-loss/types/alopecia/treatment
National Alopecia Areata Foundation. Available treatments. Accessed July 20, 2023. https://www.naaf.org/available-treatments-2/
Strazzulla LC, Wang EHC, Avila L et al. Alopecia areata: an appraisal of new treatment approaches and overview of current therapies. J Am Acad Dermatol. 2018;78(1):15-24. doi:10.1019/j.jaad.2017.04.1142
Nathan N, Almeida Gomes LL. What is alopecia areata and how is it managed? Harvard Health Blog. Published April 28, 2022. Accessed July 19, 2023. https://www.health.harvard.edu/blog/what-is-alopecia-areata-and-how-is-it-managed-202204282732
National Alopecia Areata Foundation. Insurance reimbursement. Accessed February 15, 2024. https://www.naaf.org/insurance-reimbursement/
American Academy of Dermatology. Hair loss types: alopecia areata self-care .Accessed July 24, 2023. https://www.aad.org/public/diseases/hair-loss/types/alopecia/self-care
National Alopecia Areata Foundation. Coping with alopecia areata. Accessed March 7, 2024. https://www.naaf.org/wp-content/uploads/2024/01/2024-Coping-with-Alopecia-Areata-Revised-1-11-24.pdf