Treatment of "Patchy" Alopecia Areata

Steroid Injections, Minoxidil and Topical Steroids Remain the Top Tier Treatments

Alopecia areata is an autoimmune disease that affects 1-2 % of the population. The term alopecia areata is often used as an all encompassing term for all forms on the condition despite the fact that there are many different clinical forms with different prognosis and different treatments. Examples include a single patch of alopecia areata (called alopecia areata monolocularis), several patches (AA multilocularis), alopecia areata ophiasis (AA at the back of the scalp), alopecia areata affecting all scalp hair (called alopecia areata totalis), and alopecia areata of all hair (alopecia areata universalis).

Steroid injections, topical steroids and minoxidil are among the most consistently effective treatments for patients with 1-3 small coin shaped patches of alopecia areata (ie “patchy” alopecia areata). Hair regrowth occurs in an extremely high proportion (90 % or more) of patients with a single patch with a solid plan involving steroid injections, minoxidil and topical steroids. The other option which must always be considered is ‘watchful waiting” given that a large proportion will experience spontaneous regrowth even without treatment. This is always an option during the first 6 months of any patch. Over time, it becomes less likely that a given patch will spontaneously regrow.

For 90 % or more of patients with 1-2 coin shaped patches of alopecia areata, regrowth is the expected outcome with proper treatment.

When treatments are working well, sprouting of hair is expected within 4- 6 weeks and good camouflage can be expected within 2-3 months.

If hair does not sprout in a small patch within 2 months of repeat injections, it is a sign that more aggressive treatment approaches might be needed. For example, if steroid injections were the only treatment, the topical steroid and minoxidil might be added. If steroid injections, minoxidil and topical steroids were already part of the plan, I might add antihistamines (fexofenadine, cetirizine) to the plan. Rarely, a very short course of prednisone can be considered as well but most patients with patchy alopecia can be effectively managed with steroid injections, minoxidil and topical steroids.

TREATMENT OPTIONS FOR MORE LIMITED FORMS OF ALOPECIA AREATA

TREATMENT OPTIONS FOR MODERATE TO SEVERE ALOPECIA AREATA

Alopecia areata is unpredictable so it is difficult to accurately predict how long treatment will be needed and whether another patch will form while observing the first patch fill in.

To date there remains no cure. However, treatments can be very effective for those with patchy alopecia areata.