Alopecia Areata

Alopecia Areata

Unlike many other types of alopecia, alopecia areata is not a problem with the hair cycle as I described in my previous posts.  Alopecia areata results from inflammation around the root of the hair follicle.  Inflammation prevents the growth of hair and causes hair to fall out leaving smooth patches of hair loss.  Alopecia areata can occur in limited areas or can involve the whole body in alopecia totalis.

The exact cause of alopecia areata is not clear, but those who are prone to alopecia areata will often experience a flare following times of high stress or illness. The course is unpredictable, but about 50% of patients will have regrowth of hair within one year.

Treatment of alopecia areata is an area of continued research. There are currently no treatments specifically FDA approved for alopecia areata.   A number of old and new treatments are available and effective.  We will highlight the most common treatments used in our office and those with a promising future.

Topical and Injectable Steroids

In the office, we often treat new onset alopecia areata with an injection of a dilute steroid solution directly into the spot at one-month intervals.  This stops the inflammation and allows the hairs to begin growing again.  The actual amount of steroid injected is small and generally does not have any systemic effect. A few injections may be required for complete regrowth.  Topical steroids are sometimes used for follow up or at home treatment.  Oral steroids are only used in diffuse and severe cases.  For localized areas, there is no therapeutic benefit of oral steroids over injectable steroids.

Sensitizing topicals

There are a number of topical agents that can be applied to the area of alopecia areata with the intention of severe irritation.  This severe irritation is designed to distract the immune system from continuing to attack the hair.

Other Topical treatments

Other topicals are used to potentiate the effect of topical steroids.  RetinA can be used to improve penetration and minoxidil can increase anagen active growth of new hair.

NEW – Excimer Laser treatments

Excimer Laser treatment uses NBUVB wavelengths of light directly targeted with a laser handpiece to the area.  This is a good choice for children because it is painless.  However, it requires twice weekly treatments until clear.  Insurance coverage varies.  We also use an excimer laser to treat vitiligo and psoriasis in the office.

NEWER – Microneedling with Platelet Rich Plasma (PRP) or Topical steroids

Microneedling is a procedure that uses a device to puncture thousands of holes in the skin.  There are a number of reports that show improvement of alopecia areata followed by PRP or topical steroids.  However, these procedures are not well standardized and generally not much more effective than intralesional steroids.  Cost is significant and out of pocket for most patients.

NEWEST – JAK inhibitor

Though scientifically exciting, topical treatment with these agents is still in clinical trials.

Patients who suffer from alopecia areata may find helpful support and information by joining the National Alopecia Areata Foundation.  (NAAF)

This article reviews alopecia areata in more scientific detail. 

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