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Alopecia areata before and after

This patient had rapid onset of a patch of hair loss at the front of her scalp. She was treated with 3 sessions of intralesional corticosteroids which resulted in dramatic improvement in the area of hair loss.

Treatment of alopecia areata

There are several treatment options available for alopecia areata (AA). The dermatologists at Village Dermatology are able to discuss the various treatment options and form a plan that is appropriate for each patient.

Intralesional corticosteroids: These are steroid injections into the scalp. A dilute concentration of a steroid is injected into several areas of the patch of hair loss. This is typically repeated every 4 to 6 weeks until the area has resolved. Intralesional corticosteroids is typically considered first-line treatment for AA. Although many insurance companies cover this treatment, some consider it to be a cosmetic procedure and do not cover it. However, it is a fairly inexpensive and very effective treatment option.

Topical minoxidil: Usually alone there is not much benefit to this, but sometimes in combination with other approaches, minoxidil can be beneficial.

Topical corticosteroids: Due to limited absorption, these are not typically helpful as solo therapy, but combined with other approaches, there may be some benefit.

Platelet rich plasma: Patients who don’t respond to steroid injections or topicals but do not wish to take systemic medications can often respond to platelet rich plasma therapy. This treatment, though effective with minimal risk, is not covered by insurance plans.

Oral steroids: In extreme and rapid cases, these may be needed to stop the progression of hair loss. Young, healthy patients are often able to tolerate these medications, but long-term use has significant side effects, so the risks and benefits of this will need to be discussed.

Other oral medications: Allegra and Vytorin have been used with some success in patients. In general, oral medications are reserved for more extensive cases.

Topical immunotherapy: This form of therapy is used for more widespread and extensive cases, or in cases that are unresponsive to other treatment options. This involves applying a chemical such as diphenylcyclopropenone (DPCP) in order to cause an allergic skin reaction (allergic contact dermatitis) that is similar to a poison ivy type reaction. Side effects include itching and rash at the site of application.

Oral immunomodulators: These are drugs that are used to block the immune response of the body. Drugs in the family of Janus kinase JAK inhibitors which include tofacitinib (Xeljanz) and ruxolitinib (Jakafi) are currently being tested for alopecia areata. These were initially approved to treat conditions such as rheumatoid arthritis, but they do show great promise in the treatment of alopecia areata. Currently clinical trials are in place. In addition, topical formulations are available.