How Is It Treated?

While there is neither a cure for alopecia areata nor drugs approved for its treatment, some people find that medications approved for other purposes can help hair grow back, at least temporarily. The following are some treatments for alopecia areata. Keep in mind that while these treatments may promote hair growth, none of them prevent new patches or actually cure the underlying disease. Consult your health care professional about the best option for you.

Corticosteroids–Corticosteroids are powerful anti-inflammatory drugs similar to a hormone called cortisol produced in the body. Because these drugs suppress the immune system if given orally, they are often used in the treatment of various autoimmune diseases, including alopecia areata. Corticosteroids may be administered in three ways for alopecia areata:


Local injections–Injections of steroids directly into hairless patches on the scalp and sometimes the brow and beard areas are effective in increasing hair growth in most people. It usually takes about 4 weeks for new hair growth to become visible. Injections deliver small amounts of cortisone to affected areas, avoiding the more serious side effects encountered with long-term oral use. The main side effects of injections are transient pain, mild swelling, and sometimes changes in pigmentation, as well as small indentations in the skin that go away when injections are stopped. Because injections can be painful, they may not be the preferred treatment for children. After 1 or 2 months, new hair growth usually becomes visible, and the injections usually have to be repeated monthly. The cortisone removes the confused immune cells and allows the hair to grow. Large areas cannot be treated, however, because the discomfort and the amount of medicine become too great and can result in side effects similar to those of the oral regimen.


Oral corticosteroids–Corticosteroids taken by mouth are a mainstay of treatment for many autoimmune diseases and may be used in more extensive alopecia areata. But because of the risk of side effects of oral corticosteroids, such as hypertension and cataracts, they are used only occasionally for alopecia areata and for shorter periods of time.


Topical ointments–Ointments or creams containing steroids rubbed directly onto the affected area are less traumatic than injections and, therefore, are sometimes preferred for children. However, corticosteroid ointments and creams alone are less effective than injections; they work best when combined with other topical treatments, such as minoxidil or anthralin.

 

Minoxidil (5%) (Rogaine*)–Topical minoxidil solution promotes hair growth in several conditions in which the hair follicle is small and not growing to its full potential. Minoxidil is FDA-approved for treating male and female pattern hair loss. It may also be useful in promoting hair growth in alopecia areata. The solution, applied twice daily, has been shown to promote hair growth in both adults and children, and may be used on the scalp, brow, and beard areas. With regular and proper use of the solution, new hair growth appears in about 12 weeks.

*Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.


Anthralin (Psoriatec) –Anthralin, a synthetic tar-like substance that alters immune function in the affected skin, is an approved treatment for psoriasis. Anthralin is also commonly used to treat alopecia areata. Anthralin is applied for 20 to 60 minutes (“short contact therapy”) to avoid skin irritation, which is not needed for the drug to work. When it works, new hair growth is usually evident in 8 to 12 weeks. Anthralin is often used in combination with other treatments, such as corticosteroid injections or minoxidil, for improved results.


Sulfasalazine –A sulfa drug, sulfasalazine has been used as a treatment for different autoimmune disorders, including psoriasis. It acts on the immune system and has been used to some effect in patients with severe alopecia areata.


Topical sensitizers –Topical sensitizers are medications that, when applied to the scalp, provoke an allergic reaction that leads to itching, scaling, and eventually hair growth. If the medication works, new hair growth is usually established in 3 to 12 months. Two topical sensitizers are used in alopecia areata: squaric acid dibutyl ester (SADBE) and diphenylcyclopropenone (DPCP). Their safety and consistency of formula are currently under review.


Oral cyclosporine –Originally developed to keep people’s immune systems from rejecting transplanted organs, oral cyclosporine is sometimes used to suppress the immune system response in psoriasis and other immune-mediated skin conditions. But suppressing the immune system can also cause problems, including an increased risk of serious infection and possibly skin cancer. Although oral cyclosporine may regrow hair in alopecia areata, it does not turn the disease off. Most doctors feel the dangers of the drug outweigh its benefits for alopecia areata.


Photochemotherapy –In photochemotherapy, a treatment used most commonly for psoriasis, a person is given a light-sensitive drug called a psoralen either orally or topically and then exposed to an ultraviolet light source. This combined treatment is called PUVA. In clinical trials, approximately 55 percent of people achieve cosmetically acceptable hair growth using photochemotherapy. However, the relapse rate is high, and patients must go to a treatment center where the equipment is available at least two to three times per week. Furthermore, the treatment carries the risk of developing skin cancer.


Alternative therapies –When drug treatments fail to bring sufficient hair regrowth, some people turn to alternative therapies. Alternatives purported to help alopecia areata include acupuncture, aroma therapy, evening primrose oil, zinc and vitamin supplements, and Chinese herbs. Because many alternative therapies are not backed by clinical trials, they may or may not be effective for regrowing hair. In fact, some may actually make hair loss worse. Furthermore, just because these therapies are natural does not mean that they are safe. As with any therapy, it is best to discuss these treatments with your doctor before you try them. 
In addition to treatments to help hair grow, there are measures that can be taken to minimize the physical dangers or discomforts of lost hair.

- Sunscreens are important for the scalp, face, and all exposed areas.

- Eyeglasses (or sunglasses) protect the eyes from excessive sun, and from dust and debris, when eyebrows or eyelashes are missing.

- Wigs, caps, or scarves protect the scalp from the sun and keep the head warm.

- Antibiotic ointment applied inside the nostrils helps to protect against organisms invading the nose when nostril hair is missing.

Is Research Close to Finding Better Treatments or a Cure?

While a cure is not imminent, researchers are making headway toward a better understanding of the disease. This increased understanding will likely lead the way to better treatments for alopecia areata and eventually a way to prevent or even cure it.

Alopecia research ranges from the most basic studies of the mechanisms of hair growth and hair loss in mice to testing medications and ways to apply medications to help regrow hair in people. Both the National Institutes of Health and the National Alopecia Areata Foundation support research into the disease and its treatment. Here are some areas of research that hold promise.

Developing an animal model –This is a critical first step toward understanding the disease, and much progress has been made. By developing a mouse with a disease similar to human alopecia areata, researchers hope to learn more about the mechanism of the disease and eventually develop immune system treatments for the disease in people.


Mapping genes –Scientists are studying the possible genetic causes and mechanism of the disease both in families that have one or more persons with the disease and in the general population. An understanding of the genetics of the disorder will aid in disease prevention, early intervention, and development of specific therapies.


Studying hair follicle development –By studying how hair follicles form in mouse embryos, researchers hope to gain a better understanding of hair cycle biology that may lead to treatments for the underlying disease process.


Targeting the immune system –Several new agents found to be effective in treating psoriasis may prove to be effective in alopecia areata. These drugs work by blocking certain chemical messengers that play a role in the immune response, or by interfering with the activity of white blood cells (called T-cells) that are involved in the immune system’s attack on hair follicles. New therapies for treating other autoimmune diseases like rheumatoid arthritis and lupus may also benefit patients with alopecia areata.


Finding better ways to administer drugs –One limitation of current topical therapies is getting the drug to the source of the problem. Scientists are looking for a substance that penetrates the fat under the skin to deliver medication directly to hair follicles. In laboratory animals, topically applied synthetic sacs called liposomes seem to fill the bill. Studies are still needed to show whether liposomes do the same for people.


Understanding cytokines –Chemical messengers called cytokines play a role in regulating the body’s immune response, whether it is the normal response to a foreign invader such a virus or an abnormal response to a part of the body. Researchers believe that by giving certain inflammation-suppressing cytokines, they may be able to slow down or stop the body’s abnormal response to the hair follicles. Because giving the cytokines systemically may cause adverse effects, they believe a topical medication using liposomes to get the agents to the root of the hair inside the follicle may be preferable.


Understanding stem cell biology –Epithelial stem cells are immature cells that are responsible for regenerating and maintaining a variety of tissues, including the skin and the hair follicles. Stem cells in the follicle appear to be spared from injury in alopecia areata, which may explain why the potential for regrowth is always there in people with the disease. By studying the biology of these cells, and their immediate offspring, which seem to be targeted by the immune system, scientists hope to gain a better understanding of factors that trigger the disease. 
 

How Can I Take Part in Research?

A good place to start is the National Alopecia Areata Registry sponsored by the NIAMS.

The registry, a network of five centers, will identify and register patients with the disease and collect information and blood samples (containing genes). Data, including genetic information, will be made available to researchers studying the genetic basis and other aspects of the disease and disease risk.

The registry is seeking U.S. residents with alopecia areata, alopecia totalis, or alopecia universalis diagnosed by a dermatologist. Although the registry itself will not be involved in any kind of treatment for alopecia areata, people who register will be made aware of studies for which they may qualify.

To take part in the registry, people don’t have to live near or travel to one of the five centers; however, they do have to meet some requirements to participate. For more information, log onto the registry Web site at www.AlopeciaAreataRegistry.org or have your doctor contact:

Madeline Duvic, M.D., Principal Investigator
Department of Dermatology
M.D. Anderson Cancer Center
1515 Holcombe Boulevard, Box 434
Houston, TX 77030
Phone: 713-792-5999
Fax: 713-794-1491
E-mail:
 alopeciaregistry@mdanderson.org

Where Can I Learn More About Alopecia Areata?

You can get additional information through the following organizations:

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484 or
877-22-NIAMS (226-4267) (free of charge)
TTY: 301-565-2966
Fax: 301-718-6366
E-mail:
 NIAMSInfo@mail.nih.gov
www.niams.nih.gov


American Academy of Dermatology
P.O. Box 4014
Schaumburg, IL 60168-4014
Phone: 847-330-0230 or
888-462-DERM (3376) (free of charge)
Fax: 847-330-0500
www.aad.org


National Alopecia Areata Foundation
14 Mitchell Blvd.
San Rafael, CA 94903
or
PO Box 150760
San Rafael, CA 94915-0760
Phone: 415-472-3780
Fax: 415-472-5343
E-mail:
 info@naaf.org
Web site:
 www.naaf.org