The most common treatments for alopecia areata include oral medications, topical therapies, and injections, says Kristen Lo Sicco, MD, a board-certified dermatologist at NYU Langone Dermatologic Associates in New York City.
Oral Medications
Oral medications are one of the first treatment methods your dermatologist may consider for treating alopecia areata. They include:
- Immunosuppressants Immunosuppressants work by tamping down the immune system’s attack on healthy hair follicles, which helps prevent further hair loss. If hair follicles are restored, hair regrowth may also be possible. Oral immunosuppressants include corticosteroids, such as prednisone, which can also be combined with other immunosuppressants for maximum effect. It may take up to six weeks until you see hair regrowth with oral immunosuppressants. The treatment works best for rapid or widespread alopecia areata.
- Janus Kinase (JAK) Inhibitors JAK inhibitors block enzymes that may contribute to inflammation in the body. They’re recommended as the primary treatment option for adults with severe alopecia areata. These medications include baricitinib (Olumiant), deuruxolitinib (Leqselvi), and ritlecitinib (Litfulo), though others can be prescribed off label, including ruxolitinib (Jakafi) and tofacitinib (Xeljanz). Hair regrowth, when it occurs, tends to happens after 6 to 18 months on the drug. JAK inhibitors may treat extensive hair loss related to alopecia areata, but many people have recurring hair loss once they stop taking these medications.
- Methotrexate Methotrexate (Rheumatrex) is traditionally used to treat severe psoriasis and certain cancers, such as leukemia and lymphoma. Your dermatologist may consider methotrexate for alopecia areata if you have extensive hair loss and no other treatment has worked. One study showed that methotrexate, when combined with low-dose prednisone, stimulated complete or almost complete hair regrowth. Methotrexate itself has immunosuppressant effects and may pose life-threatening risks that you should discuss carefully with a doctor before use.
Topical Treatments
Some topical treatments can help prevent further hair loss and stimulate hair growth on their own but may also be paired with oral medications. Topical therapies include:
- Contact or Topical Immunotherapy This treatment works similarly to oral immunotherapy agents but is applied directly to the skin by a dermatologist. 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. An estimated 17 to 75 percent of individuals have hair regrowth after use.
- Topical Corticosteroids Topical steroids, applied directly to the skin, are available in creams, foams, and ointments. They are safer for long-term use than oral steroids. This treatment option tends to work well in children, but it’s not as effective for alopecia areata in adults.
- Minoxidil Available over the counter for pattern hair loss, minoxidil (Rogaine) 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 get to the scalp,” says Michele Green, MD, a cosmetic dermatologist in New York City. “The increased blood flow strengthens the hair follicle, promoting growth. It also has the benefit of maintaining the hair you currently have.” Minoxidil is applied to the scalp two or three times a day. It can take a few months to see any effects. In some cases, minoxidil may also be applied to the beard and eyebrow areas to help stimulate hair growth. It’s also used in combination with other treatments, such as JAK inhibitors and intralesional corticosteroids.
- Anthralin Like monixidil, anthralin (Drithocreme HP) is a topical medication that’s applied directly to your scalp. Although traditionally used for psoriasis, anthralin may help treat alopecia areata when used in conjunction with minoxidil.
Injections
Some medications used to treat alopecia areata are applied topically. Others, such as steroids, may be injected into the area by a dermatologist. “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 Dr. Green.
Like topical and oral versions, injectable corticosteroids may be used to help stop the immune-related attacks on the hair follicles. These may be given in the scalp, as well as other areas of the body. For the best results, you may need to repeat treatment every four to six weeks, or as recommended by your dermatologist.
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