How Is Alopecia Treated?

Alopecia is a condition that causes partial or complete hair loss. There are multiple types of alopecia, each with its own causes and treatment options.

Typically, a primary care doctor or a dermatologist (a doctor who specializes in skin, hair, and nail conditions) can provide a diagnosis and treatments. Your doctor may prescribe medication or therapies to slow hair loss, regrow hair, or reduce inflammation.

There are cosmetic methods for making hair loss less visible, such as hair transplants, tattoos, and wigs. 

In general, there are several ways to manage alopecia. Talk to your healthcare provider about the best treatment plan for you.

Treatments by Alopecia Type

Different types of alopecia can cause different symptoms. Your treatment plan can vary depending on the underlying cause of your condition, as well as the pattern and location of the hair loss—on your scalp, face, or other parts of your body.

With most types of alopecia, the hair loss may be temporary. However, some types of alopecia can cause permanent hair loss when there’s scarring on your hair follicles—the pores from which your hairs grow. In those cases, you may want to visit a dermatologist for special treatments.

In general, your healthcare provider or dermatologist can prescribe treatments for slowing hair loss or for hair regrowth.

Treatments for Androgenetic Alopecia 

Androgenetic alopecia is a hereditary form of hair loss. The condition can affect men and women differently, so it is often called male-pattern hair loss or female-pattern hair loss.

Your dermatologist may prescribe one or several medications that commonly manage androgenetic alopecia. Treatments tend to act slowly and may not regrow a full head of hair.

Medications may include:

• Rogaine (topical minoxidil): This is a topical over-the-counter medication and common off-label treatment for slowing hair loss and stimulating hair growth. It is also available as an oral pill, for which you will need a prescription. Some people shed more hair upon starting the treatment. It may take about three to six months for it to take effect.
• Propecia and Proscar (finasteride): These are brands of an FDA-approved drug for treating male-pattern hair loss. It requires a prescription and is taken as a daily pill. In some cases of post-menopausal female-pattern hair loss, your doctor may prescribe an off-label finasteride. It may take about four months until you see an improvement.
• Aldactone (spironolactone): Dermatologists prescribe off-label spironolactone to treat female-pattern hair loss. It can take months for spironolactone to work.

Other treatments may be experimental therapies. These are new treatments that are still undergoing research:

• Red-light therapy: Some studies suggest that shining red light onto the scalp may promote hair growth. But more studies are necessary to confirm whether red light therapy works. 
• Microneedling: This is a procedure for stimulating hair growth, alongside drugs. A device with hundreds of small needles massages the scalp. Some studies find this treatment is effective, but more studies are necessary to confirm this. Check with your dermatologist about microneedling because they can perform the procedure safely and correctly.   
• Platelet-rich plasma injections: This experimental treatment involves drawing a sample of your blood. Then, scientists take the plasma and cells called platelets and inject them into the scalp. Some early studies suggest this treatment may be helpful, though more evidence is necessary.

Treatments for Alopecia Areata

Alopecia areata is an autoimmune disorder by which your immune system attacks the hair follicles, leading to hair falling out. As many as 50% of people enter remission (a period of significant decrease or disappearance of symptoms) spontaneously within a year.

Remission makes it difficult to judge how well the treatments work. Some people even opt to go without treatment. If your hair loss is patchy, some treatments may include:

• Topical corticosteroids: Corticosteroids can help treat inflammation and may help stimulate hair regrowth. Your healthcare provider can prescribe topical corticosteroids, which you can apply to the affected scalp or skin. One example of these is triamcinolone acetonide, two common brand names for which are Cinolar and Kenalog.
• Other topicals: Your dermatologist may also prescribe off-label topicals, such as Rogaine (topical minoxidil), Dritho-Scalp (anthralin), topical squaric acid dibutyl ester (SADBE), or topical Janus kinase (JAK) inhibitors like Opzelura. Talk to your doctor about how to apply the topical and how long to leave it on the scalp or skin.
• Injected corticosteroid: This type of corticosteroid is injected into the skin.
• Eyelash treatments: If you experience loss of eyelashes, your doctor may prescribe medication to help eyelashes grow longer, such as Latisse (bimatoprost).

When there is significant hair loss on the scalp or body, these treatments are prescribed: 

• Olumiant (baricitinib): This is a prescription drug that the FDA has approved to treat severe alopecia areata. It is available as an oral tablet and is an immunosuppressant, meaning it can help prevent your immune system from attacking your hair follicles.
• Otrexup (methotrexate): This is an off-label immunosuppressant prescription drug for treating alopecia areata. Methotrexate may be prescribed with a corticosteroid. However, these medications both come with serious side effects. 
• Contact immunotherapy: This usually involves rubbing a prescription drug—such as diphenylcyclopropenone (DPCP) or squaric acid dibutyl ester (SADBE)—on the scalp to help stimulate regrowth. Also known as topical immunotherapy, this type of treatment stops the immune system from attacking the hair. As many as 70% of people using this treatment regrow their hair.

Treatments for Telogen Effluvium

This form of alopecia occurs as a result of physiological or emotional trauma, leading to excessive hair shedding. Your healthcare provider may recommend stress management methods, like taking time to relax or meditate. They may also recommend taking supplements if you have any vitamin or mineral deficiencies, which blood tests can determine.

Treatments for Tinea Capitis

Alopecia may occur because of tinea capitis, a type of fungal infection of the scalp. This form of alopecia is resolved by killing the fungus using treatments. A treatment regimen may include:

• Antifungals: Oral antifungal medications are prescribed to treat the fungal infection on the scalp. One common type of this is Lamisil (terbinafine).
• Topical steroids: You can apply these to the scalp to help reduce inflammation, but you need to pair them with an antifungal medication because using topical steroids alone can worsen a fungal infection.
• Antifungal shampoo and creams: Though these don’t typically cure an infection, they can help prevent the spread of tinea capitis and relieve itching. 

Treatments for Traction Alopecia 

Repeated tension and pulling of the hair can result in traction alopecia. Some tight hairstyles can lead to this condition. Your doctor may recommend avoiding some hairstyles and hair products. 

A common treatment plan can include prescription corticosteroids—either topicals or injections—to reduce inflammation.

Treatments for Frontal Fibrosing Alopecia (FFA)

This form of alopecia is thought to be caused by immune cells attacking the hair follicles. Treatments for this condition may include:

• Drugs for slowing hair loss: Prescription medications like Proscar (finasteride) or Avodart (dutasteride) may be taken off-label to slow hair loss. Your doctor may also prescribe Loniten (oral minoxidil) pills off-label or recommend Rogaine (topical minoxidil), which is an over-the-counter medication—these options are taken with other treatments.
• Doxycycline: This is an antibiotic that can reduce inflammation. It comes in several brands, such as Doryx, Vibramycin, Acticlate, Monodox, and more. Your doctor may prescribe this treatment off-label to treat FFA.
• Corticosteroids: Topical or injected corticosteroids can relieve inflammation. They can also help to regrow eyebrows.
• JAK inhibitors: These drugs can treat several types of inflammatory conditions that affect the immune system. One example is Olumiant (baricitinib), which is FDA-approved to treat alopecia areata. Your doctor may prescribe these drugs off-label to treat FFA.
• Plaquenil (hydroxychloroquine): This is an immunosuppressant drug for treating malaria. A dermatologist may prescribe it off-label for this alopecia to reduce itching, pain, and other symptoms.
• Red-light therapy: Some evidence suggests that shining red light onto the scalp promotes hair growth. But as an experimental therapy, this low-level laser therapy needs further research to confirm its effectiveness.

Treatments for Trichotillomania

Trichotillomania is caused by an underlying mental health condition. It is characterized by a compulsion to pull one’s own hair out. A mental health professional can provide treatments. 

This may include a type of psychotherapy called habit reversal therapy, which can help you become aware of potential triggers while improving mental strategies to reduce hair pulling. A psychiatrist can also prescribe antidepressants off-label for this condition.

Cosmetic Options

Alongside other treatments for alopecia, you can try these cosmetic methods or procedures to help manage hair loss:

• Wigs: You can wear a wig or hairpiece to help cover permanent hair loss or while hair is regrowing.
• Tattoos: You can get tattoos to fill in your hairline (known as scalp micropigmentation), as well as your eyebrows. Though tattoos are permanent, the ink can fade somewhat after several years.
• Concealers: Concealers are over-the-counter sprays or powders that can hide hair loss. You may want to consult with your dermatologist for suggestions. 
• Hair transplant: This is a surgery by which a surgeon implants donor hair follicles into bald patches on the scalp. New hair may grow back, usually over several months.

Living With and Managing Alopecia

Most people who get alopecia live otherwise healthy lives. Here are some tips for your day-to-day hair care:

• Switch to a gentle shampoo.
• Use a moisturizing conditioner.
• Use soft towels, brush your hair gently, and stop pulling or twirling your hair.
• Use the blow dryer only on lower heat settings.
• Do not use chemical hair products and relaxers.
• Eat more protein because low-protein diets can cause hair loss.
• Speak with a dermatologist or doctor before taking any supplements. They may cause harm if you do not have a deficiency.

Additionally, wear hats and scarves to stay warm and protect from sun exposure. The places where you’ve lost hair may become more sensitive to cold temperatures. If you lose eyebrows or eyelashes, you can wear glasses and false eyelashes to protect your eyes. Try to reduce your stress because it can trigger some symptoms of alopecia. It may also help to connect with a therapist or an organization that supports people with alopecia.

A Quick Review

Alopecia is a group of conditions that cause hair loss. There are some treatments that slow hair loss and help hair grow back. However, most treatments are prescribed off-label or are experimental therapies that can take a long time to work. Some people with alopecia may use wigs, concealers, or other cosmetic procedures to make the hair loss less apparent.