For Alopecia Areata, How many visits to the doctor to get hair growth?

How many doctor visits are needed in alopecia areata?

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

Question

I have alopecia areata in an area on my scalp and I am thinking about going to the dermatologist for treatment with steroid injections. How many treatments will I need?

Answer

I am glad to know that you’re considering steroid injections. This can be a very effective treatment as we’ll see in just a minute.

For most small, coin-shaped, patches of alopecia areata, 1-2 visits to the doctor are sufficient to trigger growth. Not all patients experience growth but  90 % or more of patients with such limited degrees of alopecia areata do. Patients with many patches of hair loss or patients with larger amounts of hair loss (more than just a single patch) may not benefit from steroid injections.

It’s important to keep in mind that you may even experience spontaneous regrowth too. Patients with a patch or two of hair loss can experience regrowth sometimes even without treatment. Steroid injections is a reliable and reasonably safe way to vastly improve the odds of getting hair back.

Treatment at the right concentration and the right amount is required. For example, 0.1 ml of a 1 mg per mL injected into a coin-shaped patch is unlikely to help you get growth although 0.4 or 0.5 mL of 2.5 mg per mL is quite likely to help a small patch of this size. Some doctors use 5 mg per mL and some use 10 mg / mL although the chances of atrophy increase significantly as one increases the dose.

Finally, it’s important to keep in mind that your decision to treat this area of hair loss does not prevent a new area from forming somtime in the future. In orther words, these steroid injections are a treatment for this area of hair loss but not a cure for alopecia areata.

Although hair may grow back in the patch you are treating, there is a reasonable possibility that another patch may form in that same area or at a completely different area at some point in the person’s life. Treatment of a patch does not influence whether another patch will or will not form and a high proportion of patients do experience another episode at some point in their lives.

In summary, hair regrowth following steroid injections should be seen within 4 weeks for most patients with one or two small patches of alopecia areata. It hair does not regrow, one needs to seriously reconsider if they have the right diagnosis. Tinea capitis, lichen planopilaris, pseudopelade, dissecting cellulitis, syphilis and infiltrative diseases can rarely mimic alopecia areata.

A scalp biopsy may sometimes be needed if a small patch shows absolutely no improvement.