Alopecia areata is an autoimmune disease that leads to non-scarring hair loss. Hair loss can be mild and patchy or more severe, incorporating significant portions of the scalp. Total loss of scalp hair is also possible and referred to as alopecia totalis while loss of both scalp hair and body hair is known as alopecia universalis. This condition can be inherited, meaning those with close relatives with the disease are more likely to develop it themselves1–4. You are also more likely to develop alopecia areata if you have already been diagnosed with another autoimmune disease2–6. Some of the known triggers include viral infections, trauma, hormones and stress3,7. The good news is that alopecia areata clears up naturally with no treatment required in an estimated 80% of mild cases8. The bad news is that recurrences are common. Likewise prognosis is not as optimistic for those that develop the disease during childhood or have a more severe case8. Those with alopecia totalis or alopecia universalis have an estimated 10% chance of complete recovery8.
Fortunately, there are treatment options available. Unfortunately, these treatments are off-label with variable results9. Traditionally, corticosteroids and topical immunotherapy, sometimes in combination with minoxidil, have been used with some success. New scientific advances however may be changing the landscape. A better understanding of the disease and its underlying cause has led to a new application for biologic medication and immunomodulators. Devices such as lasers and procedures which incorporate your own growth factors are also being investigated for alopecia areata therapy. Research is still ongoing to confirm the success of these new applications but there is hope that they could help to improve the prognosis for alopecia areata.
Here are some of the top traditional treatments for alopecia areata:
For mild cases
- Intralesional steroids
- Topical steroids
For severe cases
- Systemic steroids
- Topical immunotherapy – diphenylcyclopropenone or squaric acid dibutylester
Here are some of the emerging treatments for alopecia areata:
- Immunomodulators – tofacitinib, ruxolitinib, abatacept, low-dose interleukin-2, simvastatin/ezetimibe
- Laser therapy
- Platelet-rich plasma (the vampire treatment)
Overall, you will find some of the most commonly used options here as well as exciting potential future treatments but it is still important to consult with your doctor on your individual situation.
Article by: Dr. J.L. Carviel, PhD, Mediprobe Research Inc.
- van der Steen P, Traupe H, Happle R, Boezeman J, Sträter R, Hamm H. The genetic risk for alopecia areata in first degree relatives of severely affected patients. An estimate. Acta Derm Venereol. 1992 Sep;72(5):373–5.
- McDonagh AJG, Tazi-Ahnini R. Epidemiology and genetics of alopecia areata. Clin Exp Dermatol. 2002 Jul;27(5):405–9.
- McElwee KJ, Gilhar A, Tobin DJ, Ramot Y, Sundberg JP, Nakamura M, et al. What causes alopecia areata? Exp Dermatol. 2013 Sep;22(9):609–26.
- Biran R, Zlotogorski A, Ramot Y. The genetics of alopecia areata: New approaches, new findings, new treatments. J Dermatol Sci. 2015 Apr;78(1):11–20.
- Barahmani N, Schabath MB, Duvic M, National Alopecia Areata Registry. History of atopy or autoimmunity increases risk of alopecia areata. J Am Acad Dermatol. 2009 Oct;61(4):581–91.
- Huang KP, Mullangi S, Guo Y, Qureshi AA. Autoimmune, atopic, and mental health comorbid conditions associated with alopecia areata in the United States. JAMA Dermatol. 2013 Jul;149(7):789–94.
- Peters EMJ, Liotiri S, Bodó E, Hagen E, Bíró T, Arck PC, et al. Probing the effects of stress mediators on the human hair follicle: substance P holds central position. Am J Pathol. 2007 Dec;171(6):1872–86.
- MacDonald Hull SP, Wood ML, Hutchinson PE, Sladden M, Messenger AG, British Association of Dermatologists. Guidelines for the management of alopecia areata. Br J Dermatol. 2003 Oct;149(4):692–9.
- Delamere FM, Sladden MM, Dobbins HM, Leonardi-Bee J. Interventions for alopecia areata. Cochrane Database Syst Rev. 2008;(2):CD004413.