By Dr Leila Asfour, Dr Elisabetta Muttoni and Dr Matt Harries

Dr Elisabetta Muittoni, Dr Leila Asfour and Dr Matt Harries have been kind enough to help us to start developing a set of FAQs about treatments for Alopecia Areata. Along the way they pulled together some brief notes about the treatments for Alopecia Areata, to give us an idea of the options out there. 

Do all of the treatments work?

Treatments for Alopecia Areata (AA) depend on the extent of hair loss, age of the person affected and whether they have any other associated medical problems. Here we present an overview of the more common treatments you may encounter. Not all treatments work for everyone, and currently we can’t accurately predict which treatment would work best for an individual. Another problem with the current treatment options is that, when hair does regrow, there is always a chance it may fall out again when the treatment stops.

The main aim of current treatments is to either stimulate hair growth by “distracting” the immune system away from the hair follicles or block the immune system to reduce its effect on the hair follicles. With all the treatments outlined below, we would recommend you discuss your options with your GP, Dermatologist or Trichologist before you try anything.

To understand more about what causes Alopecia Areata, have a read of this summary from Dr Kevin McElwee.

What are some of the treatments that were used in the past?

Some of the World’s oldest remedies for Alopecia Areata originate in Ancient Egypt.  One particularly popular remedy at the time was to boil ground dates, dog paws and a few hooves in oil and vigorously rub the mixture on the balding spot. Another approach advocated by the Arab polymath Thabit Ibn Qurra recommended an invigorating massage of rough fish scales on the affected area. Whereas one of the most influential physicians in greater Andalusia, in the 10^th century, formulated a concoction comprising of a mixture of mouse excrement, vinegar and frankincense! Often, the primary objective of these treatments was to encourage skin irritation using physical or chemical methods; an approach still used today (but minus the mouse poo!). In contrast, the 1950s brought about increased understanding of how the immune system works with advances in medications that work by suppressing abnormal inflammation.

What are the most common current treatments?

The most common treatments for Alopecia Areata in the NHS are corticosteroids: the aim of using steroids is to dampen down the inflammation. These come in several forms:

• Topical steroids are creams, ointment, lotions, or foams that are applied directly to the scalp or skin surface.
• Intralesional steroids are injected into the affected areas just underneath the skin using a fine needle.
• Systemic corticosteroids are taken as tablets or intramuscular injections.

Other commonly prescribed treatments for Alopecia Areata include:

• Contact immunotherapy treatments, designed to cause irritation and distract the immune system. 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.
• Dithranol cream: This is a tar-like cream or ointment (licensed for the treatment of psoriasis) that is applied regularly to the affected scalp skin to produce irritation and stimulate hair growth.
• Topical Minoxidil is available to buy over the counter as a liquid or foam that is applied to the scalp. Minoxidil is licensed to treat androgenetic alopecia; however, it is sometimes used to treat Alopecia Areata, either alone or combined with corticosteroid treatment. In the UK, one widely-available brand name of Minoxidil is ‘Regaine’.
• Bimatoprost can be used to treat short and poorly growing eyelashes.
• Immunosuppressants including Ciclosporin, Methotrexate, Mycophenolate Mofetil, Sulfasalazine and Azathioprine.

What might be available in the future?

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

• Oral JAK inhibitors: These are treatments that target different cells in the immune system, stopping them from communicating with each other, so reducing their ability to attack the hair follicle.
• 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 good results for scalp hair regrowth; however, have shown some improvement with eyebrow and eyelash regrowth.
• Biologics: these are drugs that can mimic or block the way in which immune cells signal to each other, so can decrease inflammation. Examples of biologics currently under investigation for treatment of Alopecia Areata include: Abatacept, BNZ-1, Dupilumab and Ustekinumab.
• Apremilast is a drug that reduces inflammation. There have been variable results reported in the literature up till now, including some studies showing good hair regrowth and a study showing no treatment response at all.

What other options are available?

Complementary & Alternative medicine (CAMs): Unfortunately, there is very limited evidence in the medical literature regarding alternative therapies.

• Aromatherapy: a recent paper that reviewed all CAMs found that Aromatherapy helped people with Alopecia Areata, with significant reduction in depression and anxiety symptoms, but no true effect on hair re-growth.
• Psychological studies: small studies have suggested that Hypnosis and Mindfulness are effective for improving psychological outcomes and quality of life.
• Dietary advice suggests that iron, vitamin D and zinc are important for overall hair growth and repair. A healthy balanced diet rich in these nutrients should be sufficient in ensuring normal levels are maintained.
• Faecal Transplantation (also known as Faecal Microbiota Transferor FMT) involves the transfer of gut microbiota from a healthy donor to an Alopecia Areata recipient. FMT is currently recommended for treatment of intestinal infections such as Clostridium difficile or bowel disorders such as inflammatory bowel disease. There have been case reports of patients with Alopecia Areata who underwent this procedure for other medical reasons experiencing hair regrowth.
• Platelet-Rich-Plasma Therapy: these are injections made by concentrating the patient’s own blood. Blood is separated and the part that is rich in platelets and growth factors is removed; this is then injected into the affected areas of the scalp. There have been a handful of studies reviewing this treatment in the management of Alopecia Areata, with some positive results seen in patchy Alopecia Areata.

If you are interested in reading more about the current treatments for Alopecia Areata, take a look at our Treatments for Alopecia Areata page.