Most people with alopecia areata are otherwise healthy
The hair loss is never a sign of cancer.
How do dermatologists diagnose alopecia areata?
Your dermatologist will examine the area(s) with hair loss carefully and look at your nails. Your dermatologist will also ask some questions. This may be enough to diagnose you.
Because there are so many reasons for hair loss, testing is sometimes necessary to make sure alopecia areata is the cause of your hair loss.
A blood test can look for other diseases caused by the immune system. Sometimes, other tests are necessary.
If you have alopecia areata, your dermatologist will talk with you about how the disease is affecting your life and whether treatment is recommended.
How do dermatologists treat alopecia areata?
If you just received your diagnosis and have had alopecia areata for less than a year, your dermatologist may recommend a wait-and-see approach. Your hair may regrow on its own, making treatment unnecessary.
When treatment becomes necessary, your dermatologist will consider many factors, including:
- Your age
- The amount of hair loss you have
- Where you have hair loss
It’s important to know that no one treatment works for everyone. To find one that helps, you may need to try a few types of treatment or different medications. Here’s what your dermatologist may recommend.
Children 10 years of age and younger
Alopecia areata often begins during childhood. If your child has difficulty coping with the hair loss, treatment can often help regrow hair.
Treatment options for children 10 years of age and younger are:
- Corticosteroid you apply to the bald spots: Prescription-strength corticosteroids can help regrow hair. You apply this medication once or twice a day. For children, this alone can be an effective treatment.
- Minoxidil: Also known by the brand name Rogaine®, minoxidil can help maintain the regrowth after you stop applying the corticosteroid. It has few side effects, so it’s considered a good option for children.
For children older than 10 years of age, treatment options are based on the amount of hair loss.
Patchy alopecia areata
If you are older than 10 years of age and have a few patches of alopecia areata, your dermatologist may recommend one or more of the following treatments:
- Injections of corticosteroids: To help your hair regrow, your dermatologist will inject this medication into the bald areas. These injections are usually given every 4 to 8 weeks as needed, so you will need to return to your dermatologist’s office for treatment. This is considered the most effective treatment for people who have a few patches of hair loss. In one study of 127 patients with patchy hair loss, more than 80% who were treated with these injections had at least half of their hair regrow within 12 weeks.
- Minoxidil: Also known by the brand name Rogaine®, minoxidil can help you keep the hair growth stimulated by another treatment. You will need to apply it 2 to 3 times a day. It’s helpful for the scalp, beard area, and eyebrows.
- Corticosteroids you apply: You apply this medication to the bald spots once or twice a day as instructed by your dermatologist. This medication tends to be less effective in adults than in children for hair regrowth.
- Anthralin: You apply this medication to the bald spots, let it sit on the skin for as long as your dermatologist says, and then wash it off. It will cause some skin irritation. To get the best results, you’ll also use minoxidil.
Loss of eyelashes
Our eyelashes protect our eyes. If you lose some (or all) your eyelashes, your dermatologist may include one or more of the following in your treatment plan to help protect your eyes:
- False eyelashes
- Glasses: Wearing glasses helps to protect your eyes and make the hair loss less noticeable.
- Bimatoprost (or a similar medication): This is a prescription medication that’s approved to treat a type of glaucoma and high eye pressure. The U.S. Food and Drug Administration (FDA) has also approved it to help eyelashes grow longer.
Loss of eyebrows
If alopecia areata causes you to lose your eyebrows, your dermatologist may recommend one of the following:
- Stick-on eyebrows
- Semi-permanent tattoo
- Intralesional corticosteroids: A dermatologist can inject this medication to help the eyebrows start growing again. If the injections work, applying minoxidil (also known as Rogaine®) as directed may help you keep the regrowth.
Lots of (or rapid) hair loss
When alopecia areata causes widespread hair loss, complete loss of hair on the scalp (alopecia totalis), or loss of all hair (alopecia universalis), few people regrow their hair without help.
If you have this type of hair loss, your dermatologist may recommend:
- Contact immunotherapy: Also called topical immunotherapy, the goal of this treatment is to change your immune system so that it stops attacking your hair follicles. Dermatologists have:
- Used this treatment for more than 30 years to treat widespread alopecia areata
- Found that about 60% to 70% of patients have some hair regrowth
If this is an option, you will need to return to your dermatologist’s office weekly for treatment. It’s important that you keep every appointment. Missed appointments can cause this treatment to stop working, causing the regrown hair to fall out.
The treatment itself involves your dermatologist (or nurse) applying a chemical to your bald skin. The first time you receive this treatment, a small amount will be applied so that your body can start to develop a reaction to the chemical.
Once you develop a reaction, the chemical will be applied weekly to your bald areas and left on for 48 hours. During this time, you must keep the treated skin covered and should develop a rash, complete with redness, swelling, and itch. This rash lasts about 36 hours.
Contact immunotherapy is given weekly until you completely regrow your hair or the treatment fails to regrow any hair within 6 months.
To increase the effectiveness of this treatment, your dermatologist may prescribe another treatment that you use at home.
- Methotrexate: If you have extensive hair loss and other treatments have not worked, this medication may be an option. In looking at studies of patients who have taken methotrexate to treat alopecia areata, dermatologists have found the following :
- In a small study of patients who had complete loss of hair on their scalp or entire body, 57% had complete regrowth with methotrexate.
- If this medication works for you, you should see some regrowth in about 3 months after you begin taking it.
- If methotrexate fully regrows your hair, regrowth will take 6 to 12 months.
Your dermatologist may prescribe methotrexate alone or along with a medication called a corticosteroid. Taking methotrexate and a corticosteroid, such as prednisone, can improve results.
Methotrexate has possible side effects, some of which can be serious or life-threatening. Before starting methotrexate, talk with your dermatologist about possible side effects.
- Corticosteroid you take: Taking this medication for about 6 weeks can help regrow hair. In a study of 32 patients with widespread alopecia areata, many had some regrowth after taking prednisone (a type of corticosteroid) for 6 weeks.While this medication can help regrow hair, it cannot be taken for long. Serious side effects can develop. It’s also possible that when you stop taking this medication, your new hair will fall out.
- Medication (JAK inhibitors): The discovery that this type of medication can treat extensive hair loss in people who have alopecia areata is a major research breakthrough. The JAK inhibitors that have been studied include tofacitinib, ruxolitinib, and baricitinib.While these medications help some patients when nothing else works, the patient’s hair often falls out when the medication is stopped. For this reason, studies are looking at other possibilities, such as taking this medication for a longer time or making the medication into one that you can apply to bald skin.
- Wig, hairpiece, or scalp prosthesis: Your dermatologist may recommend this option for a few reasons. Treatment takes time, and a wig or hairpiece can cover up hair loss right way. This is important if hair loss has lowered your self-esteem or is causing you to feel anxious or depressed. Treatment also has possible side effects. To avoid these, some people prefer to cover up their hair loss. It’s also possible that treatment may not work.
What exactly is a scalp prosthesis?
This is a wig that’s custom-made to help ensure a perfect fit. Other names for a scalp prosthesis are:
- Hair prosthesis
- Cranial prosthesis
All wigs are usually held on with a wig cap, such as the one this woman is wearing.
- Shaving the head or beard: This can hide patchy or diffuse hair loss on the head or beard area.
Your dermatologist may talk with you about a treatment not mentioned here. There are many treatments for alopecia areata, but no single treatment has been shown to work for everyone.
What is the outcome for someone who has alopecia areata?
Sometimes, hair regrows on its own without treatment. This happens more often when someone has a few patches of alopecia areata, which have been there for less than 1 year.
When hair fails to grow back, treatment can help.
Self-care also plays an important role in the lives of people who have alopecia areata.
Things you can do to help gain control over alopecia areata
Alopecia areata is a medical condition that can affect many areas of your life. The following may help you feel better:
- Understand that many people who have alopecia areata are otherwise healthy. Many patients confess that when they first noticed patches of hair loss, they tried to hide them. They didn’t want to tell anyone and hoped their hair would grow back. Their bald patches also left them wondering whether they had cancer or another life-threatening disease.Having alopecia areata is not a sign of cancer. In fact, many people who have alopecia areata are otherwise healthy.
- See a specialist who has expertise in managing alopecia areata, such as a board-certified dermatologist. When you see a board-certified dermatologist, you see a doctor who has the training, knowledge, and expertise necessary to diagnose and treat hair loss.A dermatologist can work with you to find the treatments best suited to help you. It’s important to understand that sometimes your dermatologist will recommend a wait-and-see approach. If you have a few patches of hair loss, it’s possible that your hair will regrow on its own.Dermatologists can also give you self-care tips that can help if you lose your eyelashes, eyebrows, the hair inside your ears, or hair on other areas of your body.
- Mention nail changes to your dermatologist. Alopecia areata can cause changes to your nails, too. If you notice a change to your nails, tell your dermatologist. If nails changes worsen, you may start to feel pain. Some nail changes can interfere with everyday activities, such as typing or playing an instrument. Your dermatologist can tell you whether you need to treat your nails.
- Protect affected areas from cold temperatures. Hair loss on your scalp, inside your ears, or in your nose can make you extremely sensitive to the cold. Keep warm with hats and scarves.
- Apply antibiotic ointment if you have lost nose hairs. Your nose hairs keep out dust, germs, and small airborne particles. If you lose your nose hair, dermatologists recommend applying antibiotic ointment just inside each nostril to keep out small particles.
- Safeguard your eyes if you lose eyebrows or eyelashes. If you lose hair in either area, here’s what you can do to protect your eyes:
- Wear false eyelashes
- Apply stick-on eyebrows
- Wear glasses to protect your eyes
- Cover up to protect your scalp. If you lose hair on your scalp, protect your skin by applying sunscreen or putting on a hat before you go outdoors. This will reduce your risk of getting sunburn and skin cancer. It will help your skin feel more comfortable.
To get the protection you need, make sure to use a sunscreen that offers broad-spectrum protection, SPF 30 or higher, and water resistance.
- Try to avoid getting stressed out. When you have alopecia areata, you can experience unexpected hair loss and regrowth. Many people living with this disease say that before a cycle of hair loss, they often feel stressed out. Learning how to manage your stress with a technique that works for you, such as meditation or yoga, may help reduce cycles of hair loss.
- Get physicals as often as your dermatologist recommends. While many people who have alopecia areata are otherwise healthy, you do have a higher risk of getting some other diseases, such as thyroid disease. The earlier these diseases are found, the easier they are to control.
- Realize that many people have trouble coping with the emotions that can unexpectedly arise with hair loss. Many people who have alopecia areata confess that their hair loss makes them feel all alone, lowers their self-esteem, or makes them feel sad and anxious. If you have these feelings, help is available. The resources on this page can help: Alopecia areata and emotional wellness (NAAF website).
- Connect with others who have alopecia areata through the National Alopecia Areata Foundation (NAAF). On its website, it says, “NAAF was established with one clear goal: To offer support to individuals affected by alopecia areata.”Today, NAAF offers a Support Group Program, the ability to speak one-on-one via phone with an experienced support contact, and a mentoring program for children living with alopecia areata. You’ll find these resources at: Support (NAAF website)