What are the treatment options for Alopecia areata?

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Last updated: March 25, 2025 • View editorial policy

From the Guidelines

Alopecia areata treatment should begin with intralesional corticosteroid injections, such as triamcinolone acetonide 5-10 mg/ml, administered every 4-6 weeks directly into the bald patches, as this method has shown to stimulate hair regrowth at the site of injection in some patients 1.

Treatment Options

The treatment of alopecia areata depends on the extent and severity of the disease. For limited patchy hair loss, intralesional corticosteroid injections are a reasonable option, with a strength of recommendation of B and a quality of evidence of III 2.

  • Intralesional corticosteroids, such as triamcinolone acetonide, can be effective in treating patchy hair loss of limited extent and for cosmetically sensitive sites such as the eyebrows 1, 3.
  • Topical corticosteroids, like clobetasol 0.05%, may be used as an adjunct therapy, although their effectiveness in promoting hair regrowth is limited 3.
  • For more extensive cases, systemic treatments, including oral corticosteroids, JAK inhibitors, or immunotherapy, may be considered, but these options are typically reserved for severe or widespread alopecia areata.

Administration and Side Effects

  • Intralesional corticosteroids can be administered using a needleless device, such as the Dermajet, which may reduce patient discomfort 1, 3.
  • The main limitation of intralesional corticosteroid injections is patient discomfort, and skin atrophy at the site of injection is a consistent side-effect, particularly if triamcinolone is used 3.

Patient Considerations

  • Patients should be aware that alopecia areata can be unpredictable, with spontaneous remissions and recurrences, and that emotional support and cosmetic solutions like wigs may be helpful during treatment.
  • Treatment should be continued until satisfactory hair regrowth occurs, typically 3-12 months depending on severity.

From the Research

Treatment Options for Alopecia Areata

The treatment options for alopecia areata include:

  • Systemic medications: baricitinib (JAK 1/2 inhibitor) and ritlecitinib (JAK 3/TEC inhibitor) are the only two EMA-approved medications for alopecia areata, approved for patients with severe alopecia areata 4
  • Other systemic medications used off-label: glucocorticosteroids, cyclosporine, methotrexate, and azathioprine 4
  • Topical treatments: high potency topical corticosteroids, which can lead to adverse effects such as tinea versicolor of the neck 5
  • Intralesional treatments: triamcinolone acetonide and methotrexate, which have shown efficacy in treating localized alopecia areata 6, 7
  • Adjuvant therapy: oral minoxidil, with limited data confirming its possible efficacy 4

Considerations for Treatment

When considering treatment options for alopecia areata, the following factors should be taken into account:

  • Disease severity: the Severity of Alopecia Tool (SALT) score and the Alopecia Areata Scale (AAS) can be used to evaluate disease severity 4
  • Patient age: baricitinib and ritlecitinib are approved for adults and individuals aged 12 and older, respectively 4
  • Potential side effects: topical corticosteroids can lead to tinea versicolor of the neck, while systemic steroids can cause adverse effects such as dysmenorrhea and osteoporosis 5, 6

Emerging Treatments

Emerging treatments for alopecia areata include:

  • Janus kinase inhibitors: baricitinib and ritlecitinib are the only two EMA-approved JAK inhibitors for alopecia areata 4
  • Low-dose interleukin-2: a novel treatment option still under investigation 6
  • Intralesional methotrexate: a promising treatment option for localized alopecia areata, with comparable efficacy to intralesional triamcinolone acetonide 7

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.