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Alopecia areata is an autoimmune disease that causes hair loss and can be treated with an array of therapies.
The disease, though often responsive to treatment, is unpredictable. What can you do about it, and how can you learn to live with it? Here is some guidance.
Is there a cure for alopecia areata?
Alopecia areata will go into remission for many people. But they may have a recurrence — meaning they will experience hair loss again — in the future. About 10% of individuals will have more widespread involvement and may need long-term treatment to grow back their hair and maintain the improvement.
What medical treatments are available for alopecia areata?
Injections or topical application of a corticosteroid — an anti-inflammatory medicine — at the scalp where the patchiness is occurring is a common treatment.
For children under 10, a topical steroid cream can be used on the bald spot to restart hair growth.
For adults and older children, injecting steroids into the scalp can cause hair growth. However, these injections can lead to tenderness and you may need to receive several rounds of injections 4 to 6 weeks apart. Adults also may be treated with topical steroids.
Irritating the skin with certain substances can promote hair growth, though it’s unclear why. Dermatologists sometimes prescribe a topical medication called diphenylcyclopropenone (DPCP). It causes a rash on your scalp and can trigger hair regrowth.
Two medications recently approved by the U.S. Food and Drug Administration (FDA) can be taken orally: baricitinib (Olumiant) and ritlecitinib (Litfulo). Both medications are known as Janus kinase (JAK) inhibitors, a class of medications that also are used to treat other skin and inflammatory conditions.
The FDA approved baricitinib for adults with severe alopecia areata in 2022. It is a once-daily pill that works by quieting down the immune cells that are involved in causing alopecia areata. Ritlecitinib is a similar type of treatment but can be used in children ages 12 and up. It was approved in June 2023 for severe alopecia areata.
What should I know about these treatments? Are there any side effects?
Treatments cleared by the FDA as safe and effective can still have side effects.
Over time, steroid injections can lead to an indentation in the skin, known as scalp atrophy. However, this usually fades with time. Injections also can lead to lighter spots of skin, called hypopigmentation.
In children, topical steroid treatment, rather than an injection, has been a preferred method of treatment, but more research is needed into pediatric treatment methods.
For ritlecitinib and baricitinib, side effects include a higher risk of serious infections. These medications also carry warnings about possible increased risks of blood clots, stroke, heart attack and malignancy. It is best to talk with your dermatologist to see if these medications are right for your situation.
Are treatments effective? How long does it take to see results?
Depending on the severity of the disease, treatments for alopecia areata are effective but can take 3 to 5 months to show results, says Dr. Costello. For those receiving treatment by topical injections, it can take 3 to 4 months to know whether they have worked.
“Most people with a limited disease will do fine,” he says. “If you have more extensive disease, treatment can be more challenging, but ritlecitinib and baricitinib are exciting new treatment options.”
Does insurance cover treatment?
That varies, but the topical and injectable steroid treatments generally are covered. Getting insurance coverage for ritlecitinib and baricitinib can be trickier, says Dr. Costello.
“Because the disease isn’t dangerous in the way that it doesn’t impact overall health, it can sometimes be difficult to get the more expensive medications covered. Insurance may require you to try multiple treatments before approving ritlecitinib or baricitinib,” he says.
The National Alopecia Areata Foundation advises those seeking treatment to consider getting prior authorization for alopecia therapy and appealing any insurance denials.
How can people manage psychological symptoms?
Hair loss can affect quality of life and can be mentally and emotionally damaging.
There are support groups sponsored by the National Alopecia Areata Foundation. The foundation also has an online collection of resources, including mentorship, a phone hotline, an annual patient conference event, and information on how to find quality wigs.
What kind of doctor should I find to treat alopecia areata? How can I find one?
It’s best to find a physician who treats skin conditions and is preferably board-certified in dermatology. The National Alopecia Areata Foundation has an online physician search tool where you can look for a local physician.
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