Alopecia is different for everyone, and what works for one person may not work for another. That’s why treating alopecia often involves a process of trial and error, which can be frustrating.
It’s important to discuss treatment options with your doctor. Since there are different types of alopecia, it's essential to understand which treatment methods apply to your specific type.
Always consult your doctor about possible treatment options. In general, a dermatologist is best equipped to provide guidance on alopecia treatment. Make sure to discuss any potential side effect risks with your doctor as well. It’s important to understand the risks of any treatment.
Click the links below to learn more about some key treatment options for alopecia — note that not all treatments are offered to all patients or for all types of alopecia.
Topical steroids come in the form of creams, ointments, lotions, or foams that are applied directly to the scalp or skin surface. Their goal is to reduce inflammation in the skin. They are one of the first-line treatment options for certain types of alopecia.
Different formulations and strengths are available. Typically, strong or very strong topical steroids are required to treat alopecia.
Topical steroids are often the first choice of treatment and may also be prescribed by a general practitioner. They are not intended for long-term regular use, as prolonged application can thin the skin.
Steroid injections are steroids that are injected directly under the skin. A small amount of steroid is injected about every 1 cm.
In the treatment of alopecia areata, injections are administered within and around the hair loss patches. In cases of scarring alopecia, injections are usually given at the active edges of the patches, where hair is still present. The aim is to reduce inflammation around the hair follicle.
The treatment may be repeated several times over a period of months. This treatment is typically used for smaller areas of hair loss and is not offered to patients with extensive hair loss, such as in totalis or universalis alopecia.
There is a risk of skin thinning and indentations at the injection sites.
Systemic steroids are taken orally in tablet form or administered via intramuscular injection. They mimic the effects of hormones produced by the adrenal glands and have anti-inflammatory and immunosuppressive properties.
Systemic steroids are usually taken for a short period to try to halt rapid hair loss. Long-term use is avoided due to the risk of serious side effects when used over an extended period.
JAK inhibitors (e.g., baricitinib and ritlecitinib) block enzymes involved in immune system activity. They are approved for the treatment of severe alopecia.
several initial tests are usually required – similar to those for any immunosuppressive treatment:
Since JAK inhibitors may increase the risk of other infections, people over 50 are advised to get vaccinated against pneumococcus, influenza, and COVID-19. Women who can become pregnant must use effective contraception, as JAK inhibitors must not be used during pregnancy or breastfeeding. Not all patients are suitable for JAK inhibitors due to other health conditions. Likewise, not all patients will respond effectively to the treatment, and it may be discontinued.
JAK inhibitors are a long-term treatment, and patients must have regular blood tests to monitor for potential side effects.
Contact immunotherapy is a treatment designed to trigger a localized allergic skin reaction (contact dermatitis) in order to stimulate hair regrowth by “diverting” the immune system from attacking the hair follicles.
Treatment begins with a high concentration of the solution applied to a small area of the scalp or forearm — this process is called sensitization, and its purpose is to make the person allergic to the solution.
After sensitization, a much lower concentration of DPCP solution is applied weekly to the affected areas of the scalp. The concentration is gradually increased depending on the skin’s reaction intensity.
This type of therapy often requires a long treatment course — sometimes longer than a year.
Only a small number of dermatology clinics offer this therapy.
Systemic immunosuppressive medications may help suppress the immune system to reduce inflammation around the hair follicles. The most commonly used immunosuppressants for alopecia treatment are methotrexate, cyclosporine, and azathioprine.
Initial testing is required:
Several initial tests are usually needed before starting immunosuppressive treatment.
For women – contraception is mandatory.
Helps maintain hair in the growth phase. May be effective as an adjunct treatment.
Available as:
Tablets may cause side effects (used as blood pressure medication).
It helps keep hair follicles in the growth phase (anagen) longer and restarts the growth phase in hairs that are in the resting phase (telogen). The exact mechanism by which minoxidil achieves these effects is not fully understood.
Treatment is unlikely to be effective if the scalp is completely bald.
Topical minoxidil is sometimes recommended "off-label" for other types of alopecia as an adjunct treatment — meaning it is used to enhance the effects of another treatment. Minoxidil can be combined with other therapies to improve hair density.
Low-dose oral minoxidil is sometimes prescribed to treat severe female-pattern hair loss. As a blood pressure medication, minoxidil in tablet form may cause side effects. It is also occasionally prescribed as an adjunct treatment (see above) for other types of alopecia.
Antiandrogen therapy is sometimes used to treat male pattern hair loss. In men, testosterone is converted to dihydrotestosterone (DHT) in hair follicles by an enzyme called 5-alpha reductase (5AR). Sensitive follicles react to this hormone by producing smaller and thinner hairs. Antiandrogen treatments like finasteride and dutasteride can help reduce DHT levels and mitigate the androgenic effect that leads to hair loss.
Older men using medications like finasteride should inform their doctor if they are undergoing a prostate-specific antigen (PSA) blood test, as these medications can artificially lower PSA levels.
The role of androgens in female hair loss is not clearly defined. However, antiandrogen therapy may be used in treating female hair loss, even though most women do not show signs of excess androgens. Antiandrogen treatment options for women may include estrogen-containing oral contraceptives and spironolactone.
Used in cases of scarring alopecia, especially when bacteria or inflammation is involved.
Tetracyclines also have anti-inflammatory properties.
Antibiotics may help some individuals with scarring alopecias, particularly when the condition is linked to bacterial infection or inflammation. They can be beneficial when bacteria play a role in causing inflammation and damage to the hair follicles. Some antibiotics, especially tetracyclines, have anti-inflammatory effects, which may help reduce inflammation associated with scarring alopecias.
Reduce inflammation in scarring alopecia.
Not steroids – safer for long-term use, even on the face.
Topical calcineurin inhibitors can help reduce inflammation and decrease the local immune response in people with scarring alopecias. These medications may help slow the progression of the condition, though they cannot regrow lost hair. They can also help manage symptoms such as itching, redness, and inflammation. Because they are not steroids, they are considered safe for use on the face as well.
Used to stimulate eyelash/eyebrow growth (includes: latanoprost, bimatoprost).
Side effects: change in iris color, darkening of eyelid skin.
Prostaglandin analogues are typically used to treat glaucoma. One of their side effects is the darkening, thickening, and lengthening of eyelashes. For this reason, some dermatologists prescribe topical prostaglandin analogues to treat eyelash or eyebrow loss in individuals with alopecia areata, when these areas are affected. Prostaglandin analogues include latanoprost and bimatoprost.
When treating eyelashes, the medication is applied only to the upper eyelid skin at the base of the lashes.
There is a risk of irreversible iris color change and darkening of the eyelid skin.
May stimulate hair growth by promoting the anagen phase.
Available as combs, caps, helmets.
Low-level laser light therapy (LLLT) may help enhance hair growth. Although the exact mechanism is not fully understood, it likely promotes the anagen (growth) phase of the hair cycle, leading to longer and thicker hair. There are different types of LLLT delivery devices, including caps, helmets, and combs. These devices can be expensive and require treatment 3–4 times per week.
Treatment is generally well tolerated, but mild scalp irritation may occur.