What are the options for alopecia areata of the eyebrows?

What are the options to improve eyebrow density in alopecia areata?

I’ve selected this question below for this week’s question of the week. It allows us to review some concepts regarding treatment of eyebrow loss in alopecia areata.

Question

I have alopecia areata of the eyebrows. I have patches of alopecia areata in my scalp too but there are not many and they grow back well with clobetasol cream. I would like to know what I can do for alopecia areata of the eyebrows.

Answer

Thank you for the question. There are really a lot of options, so you’ll want to review all of them carefully with your doctor. I always recommend a proper examination to confirm the diagnosis if there is any doubt and review of blood tests like ferritin, zinc, thyroid and vitamin D and vitamin B12 levels to make sure we have the best chances for healthy hair growth.

The options depend somewhat on how much scalp hair loss a person has. For example, a patient with 70-100 % scalp hair loss might decide to start a systemic agent like methotrexate or tofacitinib for their scalp hair loss. These treatments will help eyebrow growth.

But let’s assume for now that you just want to focus on eyebrow loss. The main “first-line” options include topical minoxidil, steroid injections, topical steroids and topical bimatoprost (Latisse). These are all off label as there are no FDA approved treatments yet for alopecia areata. I often start with monthly steroid injections with patients using minoxidil nightly and a mid potency steroid cream twice weekly. If eyebrow is not improving after 3 months, we might continue the injections and simply alternate minoxidil and bimatoprost (one applied on Monday and then second on Tuesday in this sort of alternating back and forth manner).

If this is not helping, we move on to “second-line” agents for eyebrow which includes oral minoxidil, PRP injections, topical tacrolimus and topical compounded tofacitinib. Again, you and your doctor can figure out which one of these is right for you.

If the second line agents don’t help, we move on to “third-line” agents. These include mediations that act throughout the body to stop inflammation and include oral JAK inhibitors, oral methotrexate. Sometimes we add antihistamines like cetirizine. Rarely a steroid taper can help get things growing.

I hope this helps. keep in mind we don’t know if treatments will be short term or life long in your case (or anyone’s case). You’ll want to review side effects, costs, and ease of doing the various treatments with your doctors.

Isolated eyebrow growth (without a lot of scalp hair loss) often grows very well with these first line treatments.