Alopecia areata (AA) is a type of local hair loss due to autoimmune reaction of the patient’s body against hair follicles. Alopecia Areata generally presents as circular coin shape hair loss lesions, but it can progress to involve larger areas of the scalp (Alopecia Capitis) or even the entire body (Alopecia Universalis).
Several treatment options are recommended for inducing hair growth for treatment of alopecia areata. Some patients may recover spontaneously over a period of time; because of this patients should be evaluated and selected carefully. It is important that the options to forgo treatment are reviewed with the patients, as well as discussing the high failure rate of all the various options available.
Most people who have hair loss on the hair line prefer to treat this condition more aggressively with a variety of medications. The chance of spontaneous recovery appears to be more in patients who have smaller and fewer hair loss paths.
• Topical Steroids
Topical steroids for treatment of AA has been widely used with little evidence of success. They are easy to use and more affordable to many patients. However, the current lack of evidentiary success does not make this a valuable recommendation for patients.
• Local Injection of Steroids
Infiltration of long acting corticosteroids into the AA lesions has been studied with some degree of success. Patients with smaller lesions of alopecia areata may respond better to local steroid injections.
This type of local injections of steroids is most desirable for limited lesions of cosmetically sensitive areas like hair lines and eyebrows. The most common used medication is Triamcinolone acetonide (5-10 mg/mL).
• Systemic Steroids
Systemic treatment with steroids may stimulate hair regrowth in a limited number of patients. Continued use of steroids is generally needed in most of these patients to maintain the level of hair growth. Pros and cons of long term use of steroids should be discussed with these patients before initiating systemic steroid therapy.
• Topical immunotherapy
Topical immunotherapy utilizing allergens has been studied and proven to have some success in patients. The protocol for contact immunotherapy using DPCP has been recommended. Continued use of DPCP is needed to keep the skin irritated for a long time. The inflammation seems to be able to change the progress of immune reaction that causes hair loss in alopecia areata.
Treatment should be discontinued only after full regrowth is apparent. This can take an indeterminate length of time, and during this period patients may have to tolerate inflammation of the skin. A high rate of relapse after discontinuation of treatment makes this option less desirable for most hair specialists.
• Other treatments of alopecia areata
Other medical treatments such as phototherapy, photochemotherapy, minoxidil and dithranol have shown limited improvements. Finally patients with extensive stages of hair loss with no response to treatment options may use wigs or hair systems. That is more desirable for many women with extensive hair loss due to alopecia areata that are having zero to minimal response from any other treatments.
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