Corticosteroids taken in the form of a pill are sometimes prescribed for extensive scalp hair loss to try to suppress disease activity and regrow hair.
Some patients may experience hair regrowth during the short period of time they are able to tolerate using this medication.
Healthy, young adults can usually tolerate corticosteroid pills with few side effects. However, doctors do not prescribe corticosteroid pills as often as other treatments for alopecia areata, because of the health risks and side effects associated with using them for a long period of time. It’s important to talk to your doctor about your goals for treatment and possible side effects of the medication, to be sure the benefits of using corticosteroid pills in your case are greater than the risks. As with other options, hair regrown with corticosteroid use may fall back out once treatment is stopped.
Topical immunotherapy is used to treat extensive alopecia areata, alopecia totalis and alopecia universalis. This form of treatment involves applying chemicals such as diphencyprone (DPCP), dinitrochlorobenzene (DNCB) or squaric acid dibutyl ester (SADBE) to the scalp. This causes an allergic rash (allergic contact dermatitis) that looks like poison oak or ivy, which alters the immune response.
Approximately 40% of patients treated with topical immunotherapy will regrow scalp hair after about six months of treatment.
Patients who successfully regrow scalp hair usually must continue treatment in order to maintain the regrowth. Side effects — redness, itching and a rash at the site of application — are common. Topical immunotherapy isn’t widely available and is typically performed and prescribed by dermatologists. The National Alopecia Areata Foundation can help you find a specialist who offers this treatment in the U.S.
Immunomodulators: drugs to block the immune response
Immunomodulatory drugs — specifically, Janus kinase (JAK) inhibitors — such as tofacitinib (Xeljanz) and ruxolitinib (Jakafi), are a new type of therapy being tested for alopecia areata. These medications were originally approved to treat certain blood disorders and rheumatoid arthritis. They are not approved by the FDA for alopecia areata yet, and are only available right now in the form of an oral medication. A topical formulation is currently in clinical trials in the United States.
Oral immunomodulators have proven to be effective at helping some patients with extensive alopecia areata regrow hair — even if they’ve had the disease (and hair loss) for many years. This has been observed in the small number of patients studied so far.
Because this is a new form of therapy, there isn’t a lot of information known about the side effects of taking this medication. Clinical trials are being done in order to evaluate the oral and topical medication’s effectiveness and safety in treating alopecia areata.