Treatments for Alopecia Areata

While there is no cure for alopecia areata, there are treatments that may regrow hair in both adults and children. The kind of treatment your doctor recommends depends on:

• The type or form of your hair loss
• The severity of hair loss (how much hair you have lost)
• Your age
• What you have tried already
• If you also have an atopic (allergic) condition, such as atopic dermatitis (eczema)

Effective treatments for alopecia areata block the immune system attack on the hair follicles so hair can regrow. Not all treatments work for everyone and finding the right treatment for you can take some time and patience. But there is new hope for people with alopecia areata. Since June 2022, the Federal Drug Administration (FDA) has approved three medications for severe disease, and researchers are studying many other potential treatment options.

Overview of Common Treatments

Topical Corticosteroids

Corticosteroids, or steroids, reduce inflammation around hair follicles, helping hair grow. Corticosteroids are often combined with other treatments for alopecia areata. Topical corticosteroids are a common first choice for children or for adults who can’t have injections (see below).

Intralesional Corticosteroids

The most common treatment for adults with patchy alopecia areata is intralesional injection of corticosteroids  (meaning injection within the bald patch). A very fine needle injects the medication into the areas of missing hair on the scalp or face. Some find the injections painful, while others feel only slight discomfort.  If the injections are successful, you may see new hair growth within six to eight weeks. You can repeat them every four to six weeks, stopping treatment when the hair regrows. If there is no regrowth after six months, your physician will likely stop treatment.

Corticosteroid injections don’t prevent further hair loss. Some people develop temporary depressions or “dents” (called dells) from the injections.

Oral Minoxidil

Oral Minoxidil comes as a tablet in 2.5 mg, 5 mg, or 10 mg strengths. Although some studies have shown that low doses of oral minoxidil on its own have helped hair regrow, it is most often used in combination with other treatments, such as intralesional corticosteroids or JAK inhibitors.

Duplilumab (Dupixent)

About one-third of people with alopecia areata also have atopic dermatitis or eczema. Dupilumab (Dupixent) is a monoclonal antibody that is FDA-approved for treating atopic dermatitis in adults and children as young as six months. Dermatologists may prescribe dupilumab as the first-line treatment for alopecia areata for people who also have atopic dermatitis or a family history of atopic dermatitis.

Learn more about research studies on dupilumab as a potential treatment for alopecia areata in these webinars:

Webinar

Novel developments in treating alopecia areata: What is Type 2 inflammation and why is it important?

Webinar

The connection between allergies, eczema, and alopecia areata in adults and children: Implications for new treatments

JAK Inhibitors

After decades of no new treatments, Janus kinase (JAK) inhibitors have renewed hope for people with moderate to severe alopecia areata. JAK inhibitors are immunomodulatory drugs. They modify the immune system by curbing certain enzymes called cytokines.

With alopecia areata, your immune system attacks your hair follicles, disrupting the hair growth cycle. JAKs are blood messengers. They stimulate immune cells to produce cytokines, a type of blood protein. If there are too many cytokines, you get inflammation. By taking a JAK inhibitor, you decrease the number of cytokines, decreasing inflammation. If the inflammation decreases enough, the hair may grow back.

JAK inhibitors are considered the first-line treatment for severe alopecia areata, including universalis and totalis. Dermatologists may also use oral minoxidil and/or intralesional injections with a JAK inhibitor.

Three JAK inhibitors are FDA-approved for alopecia areata, but only two are commercially available at this time:

• Baricitinib (Olumiant®, from Lilly), approved for adults 18 and older.
• Ritlecitinib (Litfulo®, from Pfizer), approved for adolescents 12 years old and up (the only JAK inhibitor currently FDA-approved for use in children.)
• Deuruxolitinib (Leqselvi®, from Sun Pharmaceuticals), approved for adults 18 and older, but is not yet available due to a court injunction following a patent-infringement lawsuit.

Webinars

Webinar

Expectations of JAK Inhibitor Treatment for Alopecia Areata Treatment

Webinar

Alopecia Areata Treatment Update 2024

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