Alopecia Areata

Alopecia areata is an autoimmune disorder in which the body’s immune system attacks hair follicles, causing patchy hair loss on the scalp and other parts of the body.

Treatments for Alopecia Areata

Topical Steroids

Topical steroids are applied topically to the scalp or skin surface as creams, ointments, lotions, or foams. Topical steroids work by reducing the skin’s inflammatory response. There are several formulas and strengths available. In order to effectively treat alopecia areata, a strong or extremely strong topical corticosteroid is typically required. The formulation recommended is crucial because some products (such ointments or creams) are frequently too greasy to be tolerated on the scalp on a regular basis.

Localised Steroid Injections to the Scalp

These steroids are administered by using a fine needle to inject them just below the skin into the affected areas. The advantage of these injections are that they have been found to be more effective than topical corticosteroids. Within four to six weeks of injection, hair growth at the injection site is typically visible when intralesional corticosteroids are successful.

Potential side effects include skin thinning which can lead to a dimple at the injection site. It is typically only used for fairly localised patches and smaller regions of alopecia areata because the injections can be painful and the total area that can be treated at once is quite modest. It is uncommon to administer intralesional corticosteroids to widespread hair loss areas.

Contact Immunotherapy

Inducing a local allergic skin reaction (contact dermatitis) is the goal of this type of therapy in order to encourage hair growth by diverting the immune system’s attention away from attacking the hair follicles. The most frequently prescribed medication in the UK is diphenylcyclopropenone (DPCP). This treatment requires time commitment as it involves initial sensitization to the solution and then weekly applications to the scalp skin.

Oral Immunosuppressant Medications:-


This is a tablet treatment that suppresses the immune system. There are a small number of trials that show Ciclosporin can stimulate hair regrowth in Alopecia Areata. It requires regular blood tests and blood pressure checks. Side effects include increased risk of infection, increased blood pressure, headaches and gum swelling. The treatment course is usually limited to six-twelve months.


This tablet is taken once a week and suppressed the immune system. It can be taken for longer durations compared to ciclosporin. Larger groups of patients have been studied using this treatment for Alopecia Areata and hair regrowth has been seen especially when combined with treatments such as corticosteroids. It also requires regaulr blood testing. Common side effects include tiredness, nausea (vomiting) and headaches; serious side effects include increased risk of infections, bleeding problems and liver abnormalities.


This works by suppressing the immune system. It is a tablet taken every day and can be taken for longer periods of time. It requires regular blood monitoring. The side effects include increased risk of infection and may cause diarrhoea, tiredness and increase the risk of skin cancer. Some studies suggest that Azathioprine can help hair regrowth and potentially work better than Methotrexate and Ciclosporin.

Oral JAK Inhibitors

A new class of medication called JAK inhibitors stop the action of enzymes linked to inflammation and hair loss. Jak-inhibitors used in alopecia areata have proven they may reverse nail dystrophy and promote hair growth. Baricitinib, also known as Olumiant, is the first JAK inhibitor recently approved by the FDA for treating severe alopecia areata. In clinical trials, Olumiant, a once-daily tablet, resulted in 1 in 3 patients with severe alopecia areata develop regrowth of hair to 80% or more of their scalp. There are currently six JAK inhibitors which have been reported to be successful in treating Alopecia Areata. These are: Tofacitinib, Ruxolitinib, Baricitinib, CTP-543, PF-06651600 and PF-06700841. These are all tablets and are generally are well tolerated. Reported side effects include nausea, headaches, increase risk of infection cold sore reactivation, anaemia, high cholesterol and potentially an increase risk of blood clots. There are reports of relapse following discontinuation of this treatment.

Topical JAK Inhibitors

Current research studies have shown that topical JAK inhibitors do not produce satisfactory scalp hair regrowth; but reveal some improvement with eyebrow and eyelash regrowth. The two main topical JAK inhibitors that have been tested and have shown some success with eyelash and eyebrow regrowth are Tofacitinib 2% ointment and Ruxolitinib 0.6% cream.These have been fairly well tolerated with no complications. The application on the skin reduces the risk of side effects compared with the oral form.

Topical and Oral Minoxidil

Minoxidil is available off prescription, as a liquid or foam that is applied to the scalp. It is usually applied once or twice a day. Minoxidil is only licensed to treat male and female pattern hair loss (Androgenetic Alopecia); however, it is also used to treat Alopecia Areata, either alone or combined with corticosteroid treatment. Low dose oral minoxidil is prescribed by Hair specialists to treat Alopecia areata.


Eye drops containing the solution bimatoprost 0.03% were first used to treat glaucoma. It was seen that the eyelashes of those receiving this treatment became thicker and longer. Since then, the US has approved the cosmetic drug bimatoprost (sold under the brand name Latisse®) to treat short, slowly growing eyelashes. Bimatoprost should never be put directly into the eyes while treating eyelashes; instead, it should only be applied at night (with a little brush or cotton bud) to the upper eyelid edge. It can take up to four months for hair re-growth to be visible; however, people have reported a noticeable difference in two months.

Bitamoprost may cause irritation of the skin and can sometimes result in permanent changes in the colour of the eyes (to brown) if applied directly into the eye. Skin pigment can also be affected (turning the eyelid skin either lighter or darker).

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