Is the treatment likely to help?
Alopecia areata is an autoimmune condition for which many treatments are possible. Patients with isolated patches of hair loss often begin with topical steroids, or steroid injections. Patients with more advanced and widespread hair loss may be prescribed other options such a diphencyprone. anthralin, prednisone, dexamethasone, methotrexate, sulfasalazine, tofacitinib and others.
Some treatments act rapidly (such as the use of steroid injections in an isolated patch of alopecia areata). Other treatments can be slower to show growth (such as DPCP or methotrexate in patients with alopecia totalis).
There are some signs that a clinician can see when examining the scalp that suggests a treatment is probably not going to help. For example, this photo shows many short “exclamation mark” hairs in a patient who has been receiving oral methotrexate and oral prednisone for 4 months. The persistence of these short hairs indicates that there is still a great deal of inflammation under the scalp despite these treatments. A new or modified treatment plan will be needed to try to stop this patient’s hair loss.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887