Question 1

Topical steroids

Accepted Answer

Topical steroids are creams, ointment, lotions, or foams that are applied directly to the scalp or skin surface. The aim of topical steroids is to reduce the inflammation within the skin. Topical steroids are one of the first-line treatment options for people with some types of alopecia. There are different strengths and formulations available. Usually, a potent, or very potent, topical steroid is needed to treat alopecia.

Topical steroids are often a first-line treatment option that can be offered by GPs. Topical steroids will not be offered as a regular long-term treatment option as prolonged use can lead to thinning of the skin (known as skin atrophy).

Topical steroids might be prescribed to patients with the following alopecia types:

alopecia areata, frontal fibrosing alopecia (FFA), lichen planopilaris (LPP), central centrifugal cicatricial alopecia (CCCA), traction alopecia.

Question 2

Intralesional steroids (steroid injections)

Accepted Answer

Intralesional steroids, or steroid injections, are steroids that are injected just underneath the skin using a fine needle. Small amounts of steroid are injected roughly 1cm apart. When used to treat alopecia areata, the injections are given into the patch of hair loss and at the patch margins. For scarring alopecias such as frontal fibrosing alopecia or LPP, the injections are generally directed at the active margins of patches where the hairs are still present. The aim is to reduce inflammation around the hair follicle.

The treatment may be repeated several times over a number of months. This type of treatment is usually only used on smaller areas of hair loss and not typically offered to those with extensive hair loss such as alopecia totalis or universalis.

Intralesional steroids are unlikely to be offered by GPs and will most likely be provided within a dermatology setting. There is a risk of skin-thinning or indents on the scalp.

In recent years, some have found challenges accessing steroid injections. Our webpage Steroid Injections - Navigating Supply Issues may be helpful for those wishing to try this treatment.

Intralesional steroids might be prescribed to patients with the following alopecia types:

alopecia areata, frontal fibrosing alopecia (FFA), lichen planopilaris, central centrifugal cicatricial alopecia (CCCA).

Question 3

Systemic steroids

Accepted Answer

Systemic steroids are taken orally as a pill or in an intramuscular injection. Systemic steroids mimic the effects of hormones produced by the adrenal glands. They have anti-inflammatory and immunosuppressive properties.

Systemic steroids are generally only used as a short-term measure to try to stop the hair from falling rapidly. Long-term use is usually avoided as there can be serious side effects when taken for longer periods.

Systemic steroids might be prescribed to patients with the following alopecia types:

alopecia areata (including totalis and universalis), lichen planopilaris (LPP)

Question 4

JAK inhibitors

Accepted Answer

Janus kinase (JAK) inhibitors are a class of medication that modulate the activity of the Janus kinase family of enzymes. These enzymes play a critical role in the signalling pathways of various cytokines involved in immune function and inflammation. JAK inhibitor medications aim to block the activity of the JAK enzymes, interfering with the signalling pathways and decreasing inflammation.

Baricitinib (brand name Olumiant) and ritlecitinib (brand name LITFULO) are the only licensed treatments for severe alopecia areata (more than 50% hair loss). Baricitinib is only licensed for those aged over 18 whilst ritlecitinib is licensed for patients aged 12 and over.

Currently baricitinib has not been recommended for routine NHS commissioning by NICE (England, Wales and NI) or SMC (Scotland). This means baricitinib is only available to patients with severe alopecia areata via a private prescription.

Ritlecitinib was recommended by NICE and SMC in Spring 2024 meaning that patients with severe alopecia areata should be able to access this treatment via NHS pathways. We have a dedicated ritlecitinib webpage designed to help people understand more about the treatment and how to access it on the NHS.

Before starting a JAK inhibitor, a number of baseline tests are usually required. These tests are generally undertaken for patients before starting any medications that act on the immune system. These tests may include blood samples to check liver & kidney function, blood count, blood fats, for evidence of serious viral infections (hepatitis & HIV) and tuberculosis (TB). Evidence that you are immune to the chickenpox virus is also checked. A chest X-ray may also be carried out. As there is an increased risk of developing shingles while taking JAK inhibitors, those aged over 50 may be recommended for shingles vaccination. You are likely to be advised to have a vaccination for pneumococcal infection, annual flu vaccines and covid vaccines.

Women who can become pregnant must be on an effective form of contraception if sexually active, as JAK inhibitors should not be taken during pregnancy or breast-feeding.

Not all patients will be suitable for JAK inhibitors due to other health issues.

Not all patients will develop an adequate response to JAK inhibitor treatment and the treatment may be stopped.

JAK inhibitors are a long-term treatment, and patients need regular blood tests to monitor for side effects.

JAK inhibitors might be prescribed to patients with the following alopecia types:

severe alopecia areata (hair loss of greater than 50%, including totalis and universalis).

Clinical trials are currently ongoing to explore new JAK inhibitor medications for alopecia areata. There are also clinical trials exploring JAK inhibitors for the treatment of some scarring alopecias such as frontal fibrosing alopecia and lichen planopilaris.

Question 5

Contact immunotherapy (DPCP)

Accepted Answer

Contact immunotherapy is a form of treatment designed to induce a local allergic skin reaction (contact dermatitis) that stimulates hair re-growth by “distracting” the immune system from attacking hair follicles. In the UK, diphenylcyclopropenone (DPCP) is the most used contact immunotherapy treatment.

The treatment is initially applied at a higher concentration to a small area of the scalp or the arm, in a process called sensitisation – this makes the person allergic to the solution being applied. After sensitisation, a much lower concentration of DPCP is applied weekly to the affected areas of the scalp. Usually half of the head is treated until hair growth is demonstrated, then the whole scalp is treated. The concentration of DPCP is gradually increased over time, depending on the level of reaction. This type of treatment requires prolonged courses, sometimes more than one year.

There are only a small number dermatology departments in the UK which offer this treatment.

Contact immunotherapy might be prescribed for patients with the following alopecia types:

alopecia areata (including totalis and universalis)

Question 6

Systemic immunosuppression

Accepted Answer

Systemic immunosuppressant medications can help to suppress the immune system to reduce any inflammation occurring around hair follicles. In the UK, methotrexate, ciclosporin and azathioprine are the most used systemic immunosuppressants for alopecia.

Before starting an immunosuppressive treatment, a number of baseline tests are usually required. These tests may include blood samples to check liver & kidney function, blood count, blood fats, for evidence of serious viral infections (hepatitis & HIV) and tuberculosis (TB). Evidence that you are immune to the chickenpox virus is also checked. A chest x-ray may also be carried out. You are likely to be advised to have a vaccination for pneumococcal infection, annual flu vaccines and covid vaccines.

Women who can become pregnant may require to be on an effective form of contraception if sexually active, as some immunosuppressive treatments (e.g. methotrexate) should not be taken during pregnancy.

Regular blood tests are essential to monitor the effectiveness of the treatment and check for any potential side effects.

Systemic immunosuppression might be prescribed to patients with the following types of alopecia:

alopecia areata (including totalis and universalis), frontal fibrosing alopecia (FFA), lichen planopilaris (LPP).

Question 7

Minoxidil

Accepted Answer

Topical minoxidil is licensed for the treatment of androgenetic alopecia (pattern hair loss) in men and women. It keeps hair follicles in the growing phase (anagen) for longer and restarts the growth phase of resting (telogen) follicles. It is not clear exactly how minoxidil causes these effects. The treatment is unlikely to be helpful if the scalp is completely bald.

Minoxidil is not prescribed for patients with androgenetic alopecia through the NHS.

Topical minoxidil is sometimes suggested for other types of alopecia ‘off-label’ as an ‘adjuvant’ treatment – meaning something that supports the effect of another treatment. Minoxidil might be offered alongside another treatment to improve hair density.

Oral minoxidil tablets are sometimes prescribed in a low dose to treat severe female pattern hair loss. Minoxidil is a blood pressure tablet and there can be side effects from taking the drug as a tablet. It is also sometimes prescribed as adjuvant therapy (see above) for other types of alopecia.

Minoxidil might be suggested for people with the following alopecia types:

androgenetic alopecia (male and female pattern hair loss), alopecia areata, lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), central centrifugal cicatricial alopecia (CCCA), traction alopecia.

Question 8

Antiandrogen treatments

Accepted Answer

Antiandrogen treatments are sometimes used in the treatment of male pattern hair loss. In men, testosterone is converted by an enzyme called 5 alpha reductase (5AR) to dihydrotestosterone (DHT) in hair follicles. Susceptible follicles react to the hormone by producing smaller finer hairs. Antiandrogen treatments, such as finasteride and dutasteride, can help to lower the level of DHT and reduce the androgenic effect that leads to hair loss.

Antiandrogen treatments can be prescribed via a private prescription but not through the NHS. There have been concerns about the side effects of these drugs. Older men taking drugs such as finasteride must let their doctor know if they have a blood test for their prostate (PSA), as these drugs can artificially lower the levels of this protein in their blood.

The role of androgens in causing female pattern hair loss is uncertain. However, antiandrogen treatments can be used to treat female pattern hair loss, although usually most women have no evidence of excessive androgens. In women, antiandrogen treatments which may be used include oestrogen-containing oral contraceptive pills and spironolactone.

Antiandrogen treatments might be prescribed for people with the following alopecia types:

androgenetic alopecia (male and female pattern hair loss)

Question 9

Antibiotics

Accepted Answer

Antibiotics can help some people with scarring alopecias, particularly when the condition is associated with bacterial infection or inflammation. Antibiotics can reduce the bacterial load in conditions where bacteria play a role in inflammation and follicular damage. Some antibiotics, particularly tetracyclines, have anti-inflammatory properties that can help to reduce the inflammation associated with scarring alopecias.

Antibiotics used to treat scarring alopecias include tetracycline and doxycycline.

Antibiotics might be prescribed to people with the following alopecia types:

frontal fibrosing alopecia (FFA), lichen planopilaris (LPP), central centrifugal cicatricial alopecia (CCCA), dissecting cellulitis, folliculitis decalvans.

Question 10

Topical calcineurin inhibitors

Accepted Answer

Topical calcineurin inhibitors can reduce inflammation and reduce local immune responses in people with scarring alopecias. These medications may help to halt the progression of the condition but will not be able to restore any lost hair. They may also help to manage symptoms like itching, redness, and inflammation. As they are not steroids, they can be safely used on the face.

Topical calcineurin inhibitors might be prescribed for people with the following alopecia types:

frontal fibrosing alopecia (FFA), lichen planopilaris (LPP), central cicatricial centrifugal alopecia (CCCA)

Question 11

Hydroxychloroquine

Accepted Answer

Hydroxychloroquine is an antimalarial drug which can reduce inflammation. It reduces the activity of immune cells and helps to reduce the autoimmune and inflammatory processes that lead to follicular damage in scarring alopecias.

Regular follow-ups are essential to monitor effectiveness and side effects. Prolonged treatment with higher doses of this drug can rarely cause damage to the eyes.

Hydroxychloroquine might be prescribed to people with the following alopecia types:

frontal fibrosing alopecia (FFA), lichen planopilaris (LPP), central centrifugal cicatricial alopecia (CCCA).

Question 12

Prostaglandin analogues

Accepted Answer

Prostaglandin analogues are used to treat glaucoma. A side effect of these medicines is the darkening, thickening and lengthening of eyelashes. As such, some dermatologists will offer topical prostaglandin analogues for the treatment of eyelash or eyebrow loss in people with alopecia areata where eyelashes/eyebrows have been affected. Prostaglandin analogues include latanaprost and bimataprost.

When treating eyelashes, the treatment is only applied to the skin of the upper eyelid margin at the base of the eyelashes.

There is the possibility of irreversible discolouration of the iris and darkening of the skin of the eyelids.

Prostaglandin analogues might be prescribed to people with the following alopecia types:

alopecia areata (where eyelashes or eyebrows are affected); frontal fibrosing alopecia (FFA - where eyelashes or eyebrows are affected)

Question 13

Low level laser light treatment

Accepted Answer

Low level laser light (LLLL) treatment may help improve hair growth. It is not clear how the treatment might work but it may promote the growing (anagen) phase of the hair cycle, resulting in longer and thicker hairs. There are different types of devices which deliver LLLL such as caps, helmets and combs. The devices can be expensive and the treatment needs to be used 3 - 4 x per week on a regular basis.

The treatment is usually well tolerated but mild scalp irritation can occur.

Low level laser light treatment might be suggested for people with the following alopecia types:

androgenetic alopecia (male and female pattern hair loss)

Question 14

What if I require extra assistance due to a disability?

Accepted Answer

The Ride Access Pass is a system Alton Towers have in place to help guests who require extra assistance or are unable to queue due to a condition or disability. This allows them access to the rides via a queuing system for themselves and up to three people (one of which must be age 14+).

The Ride Access Pass removes the need for our guests to wait within the main ride queue lines, and enter by a dedicated entrance for Ride Access Pass users.

You must apply for a Ride Access Pass in advance directly with Alton Towers. Please see more details here: Ride Access Pass | Alton Towers Resort

Question 15

Why does hair sometimes grow back white after alopecia areata?

Accepted Answer

When hair regrows after alopecia areata, it may appear white due to a lack of pigment-producing cells called ‘melanocytes’. In alopecia areata, the immune system mistakenly attacks hair follicles, causing hair loss. When hair begins to regrow, the melanocytes may not fully function, resulting in white/colourless hair. It is understood that although melanocytes are present in the regrowing white hair follicle, the cells that will form the hair are initially unable to take up pigment from the melanocytes.

Over time, the pigmentation may return to normal but for some people the hair may remain white. Unfortunately, we do not understand why some people regain hair colour and others do not.

Question 16

Can I attend if I'm from outside the UK

Accepted Answer

Yes absolutely!

We recognise that this unique opportunity will be appealing and beneficial to those not living in the UK and welcome you to come along and attend the day.

For families from outside of the UK with a child with alopecia
Due to our funding, we are only permitted to offer free places to children with alopecia from the UK. Families outside of the UK are welcome to join us however you must buy a Standard ticket (price £33) for each person* in your group including children with alopecia.

*Please note, if you have any young children under 90cm, they are still eligible for a free ticket and you are able to select that option. Please be confident that your child will still be under 90cm in height on Saturday 11th April 2026. We cannot be held responsible for Alton Towers withholding entry and you may be asked to purchase a full-price ticket from Alton Towers.

If you have any queries please get in touch at events@alopecia.org.uk

Question 17

Is alopecia 'just hair loss' or 'a cosmetic issue'?

Accepted Answer

Whilst alopecia simply means ‘hair loss’, anyone who has experienced it will know that it is far more than that. The loss of hair can present challenging physical symptoms such as difficulty in regulating body temperature, increased sensitivity to light from a lack of eyelashes and a ‘running tap nose’ from the lack of nasal hair. These are just a few examples of the physical impact alopecia can have.

Learn more about different types of alopecia

The biggest impact of alopecia is often the psychological and emotional effects on an individual. The change in appearance can lead to a loss of confidence and self-esteem. Feelings of loss of identity, femininity, masculinity, and attractiveness are also commonly reported. The feelings associated with alopecia can, for some, lead to mental health impacts such as anxiety and depression.

Unfortunately, we still hear that some people with alopecia are told it’s ‘just hair loss’ or ‘a cosmetic issue’. This might be family and friends saying something along the lines of ‘Well, thank goodness it’s just hair loss’. Or it could be a doctor informing a patient ‘Funding for treatments/wigs is not available because alopecia is determined a cosmetic issue’.

Alopecia UK strongly advocates that alopecia is viewed as a medical condition that can have significant physical and emotional impacts on an individual. It can be damaging to people affected by alopecia when it is viewed as cosmetic and the result of this can be people believing their feelings are invalid.

Alopecia UK will continue to raise awareness of the various impacts alopecia and challenge any opinions that are dismissive of the impact the condition can have on some people affected.

Question 18

Is alopecia classed as a disability?

Accepted Answer

Alopecia in its own right is not classed as a disability in legal or employment terms. For something to qualify as a disability, it needs to have a substantial and adverse effect on your ability to carry out normal day-to-day activities. Alopecia itself does not limit the ability to carry out normal day-to-day activities but the mental health impact can.

Any consequential mental health issues, such as anxiety or depression may fall into the disability definition but alopecia alone does not.

Question 19

I am a business who would like to exhibit at and/or sponsor your event, how can I do so?

Accepted Answer

Please contact our event team on events@alopecia.org.uk or 0800 101 7025 (between 10am and 4pm Monday to Friday) to discuss further.

Question 20

I’d rather not be in any event photos. How do I opt-out of photos on the day?

Accepted Answer

We like to try and capture our events on camera in order that we can show people the work we do which helps others feel able to come along to future social events and also helps us with funding requests. We will have people photographing and filming at our events however for anyone that doesn't want to be photographed/filmed don't worry! We have a process in place which allows you to let us know at the start of the day and we will keep a note to ensure you do not feature in any photos/film footage that the charity uses. If you have any questions about this please contact our events team on events@alopecia.org.uk or 0800 101 7025 (between 10am and 4pm Monday to Friday).

Question 21

I have a dietary requirement; can this be catered for?

Accepted Answer

We will do our best to cater for specific dietary requirements, however, you must let us know at least 4 weeks prior to the event so we can inform the caterers.

Question 22

Does the venue have hearing loops?

Accepted Answer

Some of the larger areas/rooms have hearing loops, however the smaller spaces do not. If this is something that may impact your enjoyment at the event, please let us know on: events@alopecia.org.uk

Question 23

I’m a little nervous about coming to the Big Weekend as it’s my first-time meeting so many people with alopecia. Is support available during the event?

Accepted Answer

Yes, the AUK staff and volunteer team will be on-hand throughout the event. We will also have ‘quiet spaces’ if you need a moment to yourself. If you would like to speak to one of the team ahead of the event to help reduce any nerves please contact our events team on events@alopecia.org.uk or 0800 101 7025 (between 10am and 4pm Monday to Friday).

Question 24

Is the Big Weekend suitable for children?

Accepted Answer

The event is suitable for adults and young people aged 13+. If you are interested in attending events suitable for children with alopecia, our Kingswood Residential, Alton Towers and regional meet-ups are the events for you.

Question 25

Can I purchase wigs or products from businesses at the Big Weekend?

Accepted Answer

That’s entirely up to you! Some of our businesses will be selling their products at the event itself, whilst others may need some time to order your item.

Question 26

Can I purchase T-shirts and/or merchandise at the Big Weekend?

Accepted Answer

Yes, absolutely but please note stock is limited.

Question 27

Do I have alopecia? How do I know if I have alopecia?

Accepted Answer

The word ‘alopecia’ simply means hair loss. If you are experiencing more hair loss than is normal for you, you are experiencing some type of alopecia. The next step is identifying which type of alopecia you have.

We recommend you first speak to a GP. If your GP is unable to make a diagnosis, they may refer you to a dermatologist. You can read more about the different types of alopecia here.

Please note, ‘alopecia’ is often used by doctors as an abbreviated way to discuss ‘alopecia areata’. This can be confusing when there are different types of alopecia too! If in any doubt as to what type of alopecia your GP is referring to, ask them to clarify.

Question 28

Should I see a dermatologist? What can I expect from a dermatology appointment?

Accepted Answer

A dermatologist is a specialist in skin conditions, including conditions affecting hair and nails. A dermatologist should have more extensive knowledge about types of alopecia than a GP. They should be able to provide you with a diagnosis (if there is any doubt) and explain more about the condition and explain any treatment options available to you.

It is likely the dermatologist will examine your scalp (and/or other areas of hair loss) and ask you questions about your hair loss to make a diagnosis. A biopsy (a medical procedure that involves taking a small sample of body tissue from the affected area) is occasionally needed to make a diagnosis. Your dermatologist will tell you if this is required. In the majority of cases of hair loss, a diagnosis is possible without the need for a biopsy.

Top Tip: Take a pen and paper to any appointment so you can make notes. It is easy to forget what is discussed. Or consider taking a friend or family member with you if you are struggling emotionally; it can be hard to take information in when we’re feeling upset.

Please note, not all dermatologists have a good understanding of hair loss conditions. Dermatology covers a huge number of skin conditions and some dermatologists specialise on particular conditions e.g. psoriasis or skin cancer. It can be helpful to find a dermatologist who specialises in hair loss.

You may find our 'How to get the most out of a dermatology appointment' page helpful.

Question 29

Where can I find a dermatologist specialising in hair loss?

Accepted Answer

There is an organisation called the British Hair and Nail Society (BHNS), made up of members who are dermatologists specialising in hair and nail conditions. They have a ‘Find a Specialist’ page on their website.

BHNS members are made up of both private and NHS doctors. Please note that this is not an exhaustive list as not all dermatologists specialising in hair loss have chosen to be members of BHNS.

Question 30

Is it normal to experience itchiness/soreness with alopecia?

Accepted Answer

Hair loss often occurs without any discomfort however some people can experience different sensations when hair falls out. As such it is hard to define what is ‘normal’. If you experience discomfort at the point of losing hair, such as feelings of itchiness, soreness, burning or aching, you are certainly not alone.

When hair loss occurs, there is inflammation around the hair follicles. It is this inflammation that can cause discomfort. Some people with alopecia report similar sensations when their hair is growing back.

Taking anti-inflammatories (such as Aspirin and Ibuprofen) or antihistamines (such as Piriton) might help to ease symptoms. Applying a cold or warm compress to the affected areas can also provide some relief. Discuss your symptoms with your GP and/or dermatologist as some physical symptoms are more typical of particular types of alopecia so it is helpful for your doctor to fully understand what symptoms you are experiencing.

Question 31

Can special shampoos or supplements help regrow hair?

Accepted Answer

There are many products marketed as helping with hair loss but rarely is there any clinical evidence to back up the claims made. We would always recommend checking the product’s website and searching for appropriate evidence prior to making a purchase. We recommend seeking advice from your GP before taking any supplement.

Please note, there is limited evidence about the use of supplements. This paper from 2017 provides a review of the role of vitamins and minerals in hair loss.

If you wish to try a shampoo or supplement, we recommend being mindful of the following:

A product that one person insists has worked miracles for them, will not work for everyone. It is also worth remembering that, with alopecia areata, spontaneous regrowth can occur at any time and may be coincidental with the time of trying a new product.
The financial cost of some hair loss products can be considerable, and most products will suggest that the effects will only be seen following months of use.
A financial and emotional investment in a product that then has no effect can lead to feelings of disappointment. It can be challenging to manage expectations when trying new products and this should be a point to consider before trying any new shampoo or supplement.

Question 32

Can I dye my hair when I have alopecia?

Accepted Answer

The latest medical advice received by Alopecia UK suggests that if hair dye solutions are applied to the scalp, the supporting literature suggests that dye might penetrate into the upper part of the hair follicle. This is unlikely to be relevant in alopecia areata as we are not aware of any evidence that hair dye affects alopecia areata, or is involved in its causation. Theoretically, it may be more important in diseases that affect the upper follicle, notably scarring alopecias, but we do not know this for sure.

Dyeing hair can cause hair loss if the hair shaft is weakened with prolonged treatments (most commonly damage occurs when taking hair from a very dark colour to a very light colour).

Some people with alopecia choose to colour their hair and find a change in hair colour can help boost confidence and even help to make the hair loss less noticeable. If choosing to colour your hair, always carry out the sensitivity patch tests when using home dye products even if you have used the product before (skin sensitivity can change with alopecia).

For best results, consider a salon treatment.

Question 33

When should I shave my head?

Accepted Answer

There is no right or wrong time to decide to shave your head. It all comes down to personal choice. Some people who are losing their hair never shave their heads. It is not an essential part of the journey.

Some might decide to shave their head once their hair loss has become impossible to conceal. Others, particularly those who are not experiencing alopecia for the first time, may decide to shave their head after the appearance of just one or two patches as they do not wish to watch any further hair fall out.

It is about deciding what you will be most comfortable and happy with and not been influenced by what others think is best for you. Only you know how you feel.

This question comes up a lot in our private Facebook group and this can be a good place to learn about the experiences of others.

Question 34

Can I get a wig on prescription through the NHS?

Accepted Answer

You might be able to get support from the NHS with getting a wig. Local NHS organisations decide which services they spend their budget on. In some local areas, this means funding wig provision, commonly two synthetic wigs per year. In other local areas, wig provision is not funded by the NHS meaning you will not be able to access a wig.

If you can access wig provision via the NHS, prescription charges may be applicable in England whilst in Scotland, Wales and Northern Ireland a prescription charge will not be payable.

Human hair wigs are not routinely offered via the NHS although some people with alopecia are able to access human hair wigs via NHS provision.

To find out if you can access wigs via the NHS and what your local provision looks like, you will need to ask your dermatologist.

Question 35

When should I tell people I am losing my hair?

Accepted Answer

It is a very personal choice when to tell others about your hair loss. Some people choose to tell people about their hair loss early on in their experience of alopecia whilst others choose to be further along in their journey before they inform others. Some may decide never to tell others about their alopecia.

Something to consider is that by being open with others about your alopecia, it can help to reduce any fear or worry of your alopecia being revealed. Secrecy about alopecia can, for some, be an additional burden. When we decide to tell someone may be different depending on who we are telling. For instance, we may tell close family and friends earlier than we tell colleagues or potential romantic partners.

Our private Facebook group can be a good place to find out the experiences of others.

Question 36

I no longer look like my passport/driving licence photo; do I need to get a new passport/driving licence?

Accepted Answer

UK passports and driving licence photocards are valid for ten years. It is common for someone’s appearance to change during that time. Naturally, having alopecia can change our appearance more significantly than others. However, you are not required to get a new passport or driving licence before it expires.

You are still able to travel with a passport if you do not bear a close resemblance to your photo. Customs staff will look at your features such as your eyes, nose and mouth. If questioned, you can simply explain you have alopecia.

If you are nervous or anxious about such interactions, you may wish to consider applying for a new passport with an updated photo. You can apply for a new passport before your current one expires.

If renewing a passport or driving licence and your appearance has changed significantly between passport photos, you may need to get someone else to sign (a countersignatory) to confirm your identity. The application form will explain this.

Question 37

Can I wear a head covering in my passport/driving licence photo?

Accepted Answer

Yes, it possible to have your head covered in a passport photo. Head coverings are accepted in passport/driving licence photos for both religious reasons and medical reasons. Alopecia is considered a medical reason. It is important that the head covering, such as hat, headscarf or bandana, does not cover or obscure the face in any way. It is recommended that a covering note is included with the application to simply state ‘I am wearing a head covering in my photo for medical reasons. I have .’

Including a short note explaining the reason for the head covering reduces the chance of the application being rejected by an examiner. This note does not need to be written by a doctor.

Question 38

I have a job interview, but I normally don’t wear a wig. Should I wear a wig to the interview or present myself as I look day to day?

Accepted Answer

If you do not normally wear a wig day-to-day, you should not feel as though you should wear a wig for a job interview. If you normally have your alopecia visible to others, you should not feel the need to conceal your hair loss for a job interview.

If you are nervous that your interviewer may misunderstand your hair loss, possibly assuming you are unwell and/or undergoing medical treatment, you could consider a brief mention about your alopecia either in the interview (or before the interview). Perhaps something along the lines of:

“Just in case you were wondering about my appearance, I have no hair/I am missing some patches of hair because I have alopecia. It doesn’t affect my general health or my ability to do the job”.

If it would be helpful to speak to others with alopecia and how they have navigated nerves about job interviews, consider joining our private Facebook group and asking for the experiences of others.

Question 39

What can I do to help my child with alopecia? What advice is available for parents of children with alopecia?

Accepted Answer

Having a child who is experiencing alopecia can be challenging, not just for the child but also parents (and the wider family). Parents are often able to resolve issues encountered by their child. Unfortunately, alopecia is not something that parents can ‘fix’.

One of the main difficulties of experiencing alopecia can be the many, many questions you and your child will have and the few answers that exist. That is why Alopecia UK is here to help and looking through our website is a great place to start.

We have created resources for parents to help guide you and your child. You can find our parents resources here .

We also recommend taking a good look through all of the webpages in the ‘Children and Young People’ section of our website. We have lots of resources that can be helpful, including story booklets, animation videos and a Schools Pack that can help with any challenges your child may encounter in their school.

Question 40

Can you recommend a supplier for wigs, headwear or permanent make up?

Accepted Answer

We are regularly asked for recommendations for suppliers of products and services. It can be daunting when considering products and services relating to alopecia and exploring the various options available.

Being a small national charity, it is not possible for us to know about all the businesses in the UK. There is a huge number of suppliers across the country and we cannot recommend one over another. It is for this reason that Alopecia UK developed its Service Directory, to help people affected by hair loss find businesses specialising in products and services relating to alopecia.

Businesses pay a fee to be included in the Alopecia UK Service Directory. The fee covers the costs of maintaining the directory and supports the work of Alopecia UK. Alopecia UK provides this information as a resource only and does not in any way endorse the products or services being offered. You can find businesses relating to alopecia on the Alopecia UK Service Directory here.

You are able to find recommendations from others affected by alopecia via the private ‘Alopecia UK Products & Services Chat Group’ on Facebook. Alopecia UK created this group to provide people with alopecia a safe space to discuss products and services, give and receive recommendations and share experiences with wigs, headwear, permanent make up and other products. You can join the Alopecia UK Products & Services Chat Group here .

Question 41

Is alopecia areata caused by stress?

Accepted Answer

The exact cause of alopecia areata is not known. It is understood to be an autoimmune condition. Research evidence is limited, however scientists believe it is likely that there are a number of causes/triggers. It is unlikely to be the same trigger/cause for everyone. These triggers could be something from inside the body or something outside the body, or a combination of both.

Stress is a commonly quoted cause of alopecia areata but there are lots of people who cannot link their alopecia areata to a stressful event or period of stress. This article from researcher Professor Kevin McElwee provides a comprehensive look at the possible causes of alopecia areata and is an interesting read for anyone wanting to understand more about potential triggers.

Question 42

Is alopecia areata an autoimmune condition/disease

Accepted Answer

It is widely accepted by many researchers and clinicians that alopecia areata is an autoimmune condition. However, not all experts believe that alopecia areata is always autoimmune in its nature. This is why we often say ‘understood to be autoimmune’.

Our blog post, 'Is alopecia areata an autoimmune condition?' explores this question in greater detail.

Question 43

Are people with alopecia areata more likely to have other autoimmune conditions?

Accepted Answer

If you have one autoimmune condition, you are more likely to develop another autoimmune condition. About 25% of people will have more than one autoimmune condition. In addition, it is more likely for those with autoimmune conditions to have close family members with autoimmune conditions. Other autoimmune conditions include:

Coeliac Disease
Crohn’s Disease
Fibromyalgia
Hashimoto’s Thyroiditis
Lupus
Multiple Sclerosis
Psoriasis
Rheumatoid Arthritis
Vitiligo

This is not an exhaustive list of autoimmune conditions.

Question 44

Will my child inherit alopecia areata from me?

Accepted Answer

It is understandable that people with alopecia areata would have concerns about their children also having the condition. Alopecia areata is complex and it is not possible to predict whether or not your child will develop the condition.

However, scientists believe that multiple factors (both genetic and in the environment) are needed in order to trigger the disease, not just simply family heredity.

Most parents will not pass alopecia areata along to their children.

Question 45

Is there a cure for alopecia areata?

Accepted Answer

At present, there is no cure for alopecia areata, although the hair may return without any treatment.

There are different treatment options but none are guaranteed to work.

Question 46

Can a few patches of alopecia areata lead to total hair loss?

Accepted Answer

Alopecia areata most typically displays as small round bald patches. This could be just one patch or a number of patches. When diagnosed with alopecia areata, it is easy to panic that all hair will fall out. However, it is worth noting that 80% of people with just a few patches of alopecia areata experience regrowth without treatment.

Unfortunately, there is no way to determine whether someone will be in the 80% who will experience regrowth or the 20% who will continue to experience hair loss, either with continued patches or more extensive or total hair loss.

Question 47

Can someone from the Alopecia UK team come to my fundraising event?

Accepted Answer

Being a small charity with a small team, we are not always able to attend fundraising events. If we are able to fit it into our schedules, we would love to but realistically there are many times when we cannot. If your fundraising event is local to a staff member, we will try our best to support.

Sometimes we may be able to send along a volunteer (who know lots about the charity and has alopecia themselves) on our behalf.

If you’d like to enquire about Alopecia UK attending your fundraiser, please email info@alopecia.org.uk

Question 48

How can I fundraise for Alopecia UK?

Accepted Answer

There are lots of ways you can get involved with fundraising for Alopecia UK and we would be extremely grateful to have your support. Alopecia UK relies on the support of fundraisers and donors to continue our work to improve the lives of those affected by alopecia.

We have a section of our website dedicated to inspiring and supporting fundraisers. We recommend you take a look through our fundraising pages and get in touch if you have any queries or need any support.

Visit our fundraising section here.

Question 49

How can Alopecia UK help me to meet others with alopecia?

Accepted Answer

Alopecia UK specialises in peer support. We understand the importance of being in touch with others who understand the alopecia journey. We facilitate this in the following ways:

Private Facebook Groups

Our busiest peer support spaces are our private Facebook groups, with lots of daily content on different topics in our main group.

FIND ALL ALOPECIA UK PRIVATE FACEBOOK GROUPS HERE

Online Groups

We host online support meetings, perfect for those who either cannot get along to a face-to-face meeting, or who perhaps prefer meeting people online.

DISCOVER ONLINE GROUP OPTIONS HERE

Local Support Groups

Alopecia UK has face-to-face support groups across the UK, in cities and towns where we have a volunteer willing to lead a group.

FIND YOUR NEAREST SUPPORT GROUP HERE

Events

We host regional and national events which provide an opportunity to meet others who have experience with alopecia.

Find Alopecia UK events here

Question 50

I am a business who supplies wigs and headwear. Can I have access to your membership, or can you advertise my business on your social media channels?

Accepted Answer

Alopecia UK is not a membership charity. We want all our information to be free at the point of access for all those who need it. As such we need to find alternative ways to help financially sustain the charity. One of these ways is through our Service Directory. Our directory provides businesses with the opportunity to list their products and/or services on the Alopecia UK website. This creates a much-needed funding stream for the charity, an additional place for advertising for the businesses and a helpful resource for those with alopecia.

Many businesses also look at this as their opportunity to support a charity that supports many within their own client base or some view it is part of their Corporate Social Responsibility model. By having a listing on Alopecia UK's Service Directory, businesses are also able to join our private Alopecia UK Products and Services Chat Facebook group and participate in our ‘Free to Promote Fridays’. If your business would like to join the Alopecia UK Service Directory, please apply here.

Question 51

Can you recommend a hairdresser who is sensitive to those with hair loss?

Accepted Answer

Firstly, it is worth remembering that hairdressers come into contact with alopecia on a very regular basis. They are often the first person to spot hair loss. Most hairdressers will automatically treat their clients sensitively regarding their hair loss.

MyNewHair is a charity founded by and inspired by Trevor Sorbie MBE. MyNewHair provides public advice and support a national network of independent salons and professionals who provide a wig styling service for people suffering from cancer and medical hair loss. Each professional who signs up to MyNewHair’s network pledges their commitment to responsible training and providing a caring and sensitive service for their clients. Many MyNewHair stylists are trained to cut and style wigs and they have a 'salon finder' on their website. You can find more information about MyNewHair here.

Question 52

Does Alopecia UK accept wig donations? Can I send my unwanted wigs to Alopecia UK?

Accepted Answer

Alopecia UK does not have the resources to be able to process any wig donations. Currently we do not accept donations of unwanted wigs.

However, there is a wig bank run by Linzi Brack of Diamond Hair Solutions. To date, Linzi has raised over £15,000 for Alopecia UK by recycling unwanted wigs and selling them and donating a percentage of the proceeds.

You can read more about the Diamond Wig Bank North East, including details of how to send any unwanted wigs to Linzi here.

Question 53

Does Alopecia UK accept hair donations?

Accepted Answer

Alopecia UK does not accept hair donations. Being a small charity, we do not have the resources to process hair donations. There is a charity called the Little Princess Trust (LPT) that accept hair donations and provide free wigs to children and young adults aged 24 and under with medical hair loss, including cancer and alopecia.

Some individuals who cut their hair as a way of raising awareness, ask their family and friends to sponsor them for the haircut. Many choose to do this to raise much-needed funds for Alopecia UK, whilst donating the hair donation to Little Princess Trust. This is a great way to support two causes.

Question 54

Can I use your logo?

Accepted Answer

If you’d like to use our logo as part of your fundraising for publicity or in any other way, please contact us (info@alopecia.org.uk) and we will consider your request.

Question 55

Can I get an Alopecia UK t-shirt?

Accepted Answer

We will send an email to the contact details associated with each new fundraising page that is set up, offering an Alopecia UK t-shirt. Please ensure you enter your email address carefully when setting up your account on our website. Please check your spam folder in case our email reaches that.

If you are fundraising with an activity that does not involve setting up a fundraising page, email info@alopecia.org.uk to request a t-shirt and one of the team will try to help.

We are pleased to offer one free t-shirt per fundraising activity. If more t-shirts are required, we may need to charge to help cover our costs. Please contact us to discuss if you need additional shirts.

Question 56

How do I set up a fundraising page for Alopecia UK?

Accepted Answer

It is simple to set up a fundraising page on our website. Just follow the instructions provided and we will approve your page as soon as we can. Create your fundraising page here. If you set up your page on a weekend, you will need to wait until the next working day for your page to be approved.

Alternatively, if you prefer the Justgiving platform you can set up a fundraising page with them here. We encourage fundraisers to set up pages on our website because the fees are lower than Justgiving. We are happy to welcome pages on either platform.

Question 57

What fundraising events do you have that I can get involved in?

Accepted Answer

Being the small charity we are, we do not have our own fundraising events for you to join. We rely on inspiring individuals to do their own thing to raise funds and awareness for Alopecia UK. If you are looking for inspiration, check out our Fundraising Ideas - A-Z. Or have a browse on our website to see what others have done to raise funds for Alopecia UK.

We do not have the capacity to purchase large numbers of places in externally organised challenge events. Again, we rely on individuals securing their own places and using those to raise funds for Alopecia UK. There are lots of different events from a variety of event organisers across the UK.

Question 58

I don't want my photo taken and shared publicly, what can I do?

Accepted Answer

We want everyone to come along and have a good time at Alton Towers and don't want anyone worrying about photos of them going out publicly via Alopecia UK. As mentioned in our Terms and Conditions we will be taking photos at this event and usually have a photographer or two following some of the groups round the park. We can't guarantee that you won't get captured on camera, however, on the day you will be able to register for ‘no photos’, this will entail taking one photo of you on the day so we can identify you in our photos afterwards.

We ask that you make a conscious effort to remove yourself from posed group photos where possible as these will be used publicly and to advertise future events.

It is your responsibility to seek an AUK staff member on the day of the event and explain that you do not wish to be in photos. Once we have your photo for our records, we will use this to ensure your image is removed or blurred out from our photos before anything goes out publicly on Alopecia UK website and social media.

(Please note that we cannot guarantee that other attendees won't take and share pictures on their own social media. Please see Alton Towers own photo policy for how they might use any of their photos taken round the park).

Question 59

What age does my child need to be?

Accepted Answer

This event is suitable for children with alopecia aged 7-17.

Children under the age of 7 may be welcome to attend but may not be able to take part in most of the activities due to their size. Please contact events@alopecia.org.uk to discuss further .

Our booking will have private access to a Yurt tent on our campsite that will be open to those who can't or don't want to take part in any activities. We will bring along some arts and crafts and small games for inside the Yurt.

Question 60

Future Treatments for Alopecia Areata?

Accepted Answer

Possible Future Treatments for Alopecia Areata:

These treatments are currently not available on the NHS, but this may change in the future. Some of these treatments are still being reviewed to assess whether they are appropriate and useful for Alopecia Areata patients.

Oral JAK inhibitors

Oral JAK inhibitors to treat Alopecia Areata are still being studied. These are treatments that target different parts of the Janus Kinase enzyme family, which are important steps in causing inflammation, including the inflammatory pathways that occur in active Alopecia Areata. Therefore, when these are blocked, inflammation is reduced. 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 tablet medications.

Advantages

Reports suggest they may be very effective in causing hair regrowth in some patients with very extensive hair loss or who have had Alopecia Areata that has been resistant to other treatments over the years. However, we are still awaiting clinical trial results to say for certain. These drugs are generally are well tolerated.

Disadvantages

These are novel treatments; therefore, we are still trying to understand how effective they are and their side effect profile in the long term. Side effects that have been noted already include nausea, headaches, increase risk of infection (including herpes (cold sore) virus reactivation), anaemia, high cholesterol and potentially increase risk of blood clots. There are reports of relapse following discontinuation of this treatment.

Topical JAK inhibitors

Topical JAK inhibitors to treat Alopecia Areata are still being studied. Current studies have shown that topical JAK inhibitors have not shown satisfactory results for scalp hair regrowth; however, have shown 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.

Advantages

Studies have shown some success with re-growth of eyelash and eyebrow hair. 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.

Disadvantages

Poor response on the scalp.

Ustekinumab

Ustekinumab reduces inflammation by blocking the activity of chemical signalling molecules (called cytokines), specifically interleukin 12 and 23, that trigger inflammation. It is commonly used in psoriasis and Crohn’s disease. It has been shown in a small case series that it can help hair regrowth in moderate to severe Alopecia Areata. It is injected under the skin of the stomach, thighs or upper outer arms.

Advantages

Initially patients have an injection on week 4 of treatment and after that every 12 weeks.

Disadvantages

It can increase the risk of serious infections. Patients can experience reactions at the injection site, fatigue, headaches and sinusitis. We do not have sufficient evidence with regards to the efficacy of this treatment for Alopecia Areata. There have also been case reports of patients developing Alopecia Areata during their Ustekinumab injections for other conditions. Ustekinumab is very expensive.

Dupilumab

Dupilumab is a biologic medication given through a subcutaneous injection (injection under the skin) that works by blocking chemical messengers (also known as cytokines) in the body called interleukin 4 (IL-4) and interleukin-13 (IL-13). It is currently being used to treat atopic eczema on the NHS. One study has shown a significant improvement in Alopecia Totalis following dupilumab treatment whereas another paper reported cases of Alopecia Areata developing shortly after starting dupilumab for their eczema. Therefore, further clinical trials are needed to assess the role of dupilumab in the treatment of Alopecia Areata.

Advantages

It is an injection every 2 weeks. It is shown to be very well-tolerated with minimal side effects.

Disadvantages

The main side effect reported is conjunctivitis (inflammation of the eyes) causing redness, itch and discharge. Other side effects reported are headaches, cold sores and eczema around the eyes. Further clinical trials are necessary before this treatment can become routinely available for Alopecia Areata. Dupilumab is classed as a high-cost drug, so very expensive.

Apremilast

Apremilast is an inhibitor of the phosphodiesterase 4 (PDE4), which reduces inflammation. PDE4 has been found to be expressed in patients suffering with Alopecia Areata. It comes in the form of a pill that is taken daily. It has been approved and used for the treatment psoriasis and Psoriatic Arthritis. A study of the safety and efficacy of Apremilast in patients with moderate to severe Alopecia Areata is currently in progress. There have been variable results reported in the literature up till now, including good hair regrowth and a study showing no treatment response at all.

Advantages

Good clinical response in some Alopecia Areata patients. Safe and well tolerated. Oral tablet.

Disadvantages

Further clinical trials are necessary before this treatment can become routinely available in the treatment of Alopecia Areata. The main side effects are diarrhoea, headache, nausea, fatigue and weight loss.

BNZ-1

This is an intravenous medication (given through the vein) currently still being tested in clinical trials. BNZ-1 is an inhibitor of inflammatory pathways involving interleukins: IL-2, IL-9, and IL-15. These have been shown to be increased in Alopecia Areata. The idea is for treatment to be given weekly for 3 months to adults diagnosed with moderate to severe alopecia areata. Study results are not available yet.

Abatacept

Abatacept is a fusion protein of cytotoxic T-lymphocyte associated antigen 4 (CTLA-4). It improves inflammation by reducing the activation signals to the white blood cells. It is currently being used for conditions such as Rheumatoid Arthritis, Juvenile Idiopathic Arthritis, and Psoriatic Arthritis. It is also given as an injection under the skin, consisting of weekly injections for 6 months, with an additional 6 months of follow up. It is still being reviewed in a clinical trial for Alopecia Areata and results are currently pending. The side-effects that have been reported up till now are risk of serious infection, injection-site reaction, sinusitis, headaches, and high blood pressure.

Question 61

Immunosuppressive Treatments for Alopecia Areata

Accepted Answer

Ciclosporin

Ciclosporin is an oral treatment that suppresses the immune system. It is commonly used in several inflammatory skin conditions such as Psoriasis and Eczema. It comes in the form of capsules that are taken twice a day.

Advantages

It is a tablet form taken every day, therefore easy to take. There are a small number of trials that show evidence that Ciclosporin can stimulate hair regrowth in Alopecia Areata.

Disadvantages

It requires blood test monitoring because of the effect it can have on the kidneys, which also means regular clinic appointments. For this reason, the treatment course is usually limited to six months. Other side effects to be aware of include increased risk of infection, increased blood pressure, headaches and gum swelling.

Methotrexate

Like Ciclosporin, methotrexate is commonly used to treat a number of inflammatory skin conditions such as psoriasis and eczema. It also works by suppressing the immune system.

Advantages

It is a tablet taken once a week. It can be taken for longer periods of time than Ciclosporin. Larger groups of patients have been studied using this treatment for Alopecia Areata and hair regrowth has been observed, especially when combined with other treatments such as corticosteroids.

Disadvantages

It requires regular blood test monitoring because of the effect it can have on the liver and blood cells. Women of childbearing age, and men, are advised to use effective contraceptive precautions during treatment and for 6 months after stopping as it can have severe effect on the unborn baby. Common side effects include tiredness, nausea (vomiting) and headaches; serious side effects include increased risk of infections, bleeding problems and liver abnormalities.

Azathioprine

Azathioprine is a medication that works by suppressing the immune system. It is often used in inflammatory conditions, including severe Eczema.

Advantages

It is a tablet form taken every day, therefore easy to take. It can be taken for long periods of time such as months or years. Azathioprine has been shown to help hair regrowth in a small number of cases reported in the medical literature.

Disadvantages

It also requires regular blood test monitoring as it can affect the blood cells and liver. It can also increase the 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.

Question 62

Minoxidil and Bimatoprost for Alopecia Areata

Accepted Answer

Topical 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.

Advantages

It can be applied at home and has minor side effects only. If effective, hair re-growth can take four to six months to appear.

Disadvantages

It is less effective on its own for Alopecia Areata, and therefore is often only used as an additional treatment alongside some of the other treatments mentioned here. It can cause dryness, redness or irritation when regularly applied to the scalp and may stimulate facial hair growth in some women.

Bimatoprost (eyelashes only)

Bimatoprost 0.03% is a solution originally used as an eye drop to treat glaucoma. It was observed that in people using this treatment their eyelashes grew thicker and longer. Since then Bimatoprost (marketed under the name Latisse®) has been approved as a cosmetic product in the US to treat short and poorly growing eyelashes. When bimatoprost is used to treat eyelashes, it should only be applied to the upper eyelid margin at night time (with a small brush or cotton bud) but never put directly into the eyes.

Advantages

It can take up to four months for hair re-growth to be visible; however, people have reported a noticeable difference in as little as eight weeks.

Disadvantages

It can cause irritation in the skin, can cause a permanent changes in the colour of the eyes (to a dirty brown) if applied directly into the eye, and skin pigmentation may also be affected (turning the eyelid skin either lighter or darker).

Question 63

Common Treatments for Alopecia Areata

Accepted Answer

Topical corticosteroids

Topical steroids are creams, ointment, lotions, or foams that are applied directly to the scalp or skin surface. The aim of topical steroids is to dampen down the inflammation within the skin. There are different strengths and formulations available. Usually a potent or very potent topical corticosteroid is needed to treat Alopecia Areata, as weaker products tend to be less effective. The formulation prescribed is important, as some preparations (e.g. ointments or creams) are often too greasy to be tolerated regularly on the scalp.

Advantages

Studies have demonstrated hair regrowth with the regular use of potent topical steroids. They are commonly used in children and adults, as they are easy and painless to apply.

Disadvantages

Their effectiveness is limited by their absorption through the scalp. If used excessively over a long period of time, there is the potential risk of skin thinning and enlarged blood vessels in the skin, causing it to look red.

Intralesional corticosteroids

These are steroids that are injected into the affected areas just underneath the skin using a fine needle. Examples of intralesional corticosteroids are hydrocortisone acetate and triamcinolone acetonide.

Advantages

Intralesional corticosteroids have shown to be more effective than topical corticosteroids for hair regrowth. When intralesional corticosteroids are effective, hair growth is usually seen at the site of injection within four to six weeks.

Disadvantages

There is a risk of skin thinning that can cause a temporary depression (or dint) at the site of injection. The needle prick can be uncomfortable and the whole area that can be treated in one go is quite small; therefore, it is usually only used for fairly localised patches and smaller areas of Alopecia Areata. Intralesional corticosteroids are not routinely offered to patients with Alopecia Totalis or Alopecia Universalis. Steroid injections can only be performed by medically qualified practitioners.

Systemic corticosteroids

These are steroids that are taken orally as a pill or injection in the muscle (intramuscularly). Examples are oral prednisolone or intramuscular triamcinolone acetonide (Kenalog). Systemic corticosteroids mimic the effects of hormones your body produces naturally. When systemic corticosteroids are given in doses that exceed your body's usual levels, they suppress the immune system, which can allow hair to re-grow. Systemic steroids are often used as a short-term measure to try to stop the hair from falling rapidly or “kick-start” the hair to regrow. Long-term systemic steroids are usually avoided as they can cause serious side effects when taken for too long.

Advantages

It is a tablet taken every day, therefore easy to take. This treatment can be used for patchy Alopecia Areata and more extensive hair loss (Alopecia Totalis or Universalis). Treatment with systemic corticosteroids will produce hair re-growth in some patients.

Disadvantages

Most young patients tolerate this well with no side-effects. Some side-effects include heartburn, increase risk of infection, weight gain and restlessness/mood disturbance. Long-term systemic corticosteroid use is associated with serious side effects including diabetes, high blood pressure and bone thinning. This treatment also has a high rate of hair loss recurring once the treatment is stopped.

Contact Immunotherapy

The aim of this form of treatment is to induce a local allergic skin reaction (contact dermatitis) that stimulates hair re-growth by distracting the immune system from attacking the hair follicles. In the UK Diphenylcyclopropenone (DPCP) is the most commonly used treatment.

In contact immunotherapy, the treatment is initially applied at a higher concentration to a small area of the scalp or the arm, in a process called sensitisation – this makes the person allergic to the solution. Two weeks later a weaker concentration is then applied to the affected areas on the scalp. The solution usually remains on the skin for up to 24 hours and is then washed off. The aim of treatment is to cause a low-level reaction lasting 24-36 hours, with the scalp feeling a little itchy, red and flaky. The strength of the medication is gradually increased, depending on the level of the reaction.

Advantages

Current research shows that 50-60% of patients with Alopecia Areata achieve a worthwhile response, although those with more extensive hair loss (e.g. Alopecia Totalis and Alopecia Universalis) do less well. Treatment is usually continued weekly until the hair has re-grown, which may take up to 12 months to achieve.

Disadvantages

This treatment requires a significant time commitment as usually it is only available in hospital departments and requires repeated applications over a period of months; home treatment is not widely available in the UK at the moment. The side effects of contact immunotherapy include dryness/ redness of the skin (appears like Eczema), hives, small itchy blisters on the feet/ hands (called Pompholyx) and the loss of pigment in some areas leading to white patches (called Vitiligo). The lymph glands in the neck and armpits may become enlarged as a response to the treatment. It is important to avoid these medications touching other areas of the body; therefore, gloves and other PPE should be worn by the practitioner applying it.

The team at Salford NHS Foundation Trust have very kindly put together these helpful videos on:

DPC Sensitisation: https://youtu.be/ONONMpXRH_w

DPC Treatment: https://youtu.be/8sw3-oRLGBs

Question 64

Where can I contact Alopecia UK with any questions?

Accepted Answer

You can contact Alopecia UK via email at events@alopecia.org.uk or by phone on 08001017025.

Is alcohol allowed on site?

How can I get to the Kingswood Centre?

Can I meet other families beforehand?

Do we have the whole centre to ourselves?