How is alopecia areata treated?

When a solitary lesion of alopecia areata is small (,5 cm in diameter), no treatment may be needed. The prognosis for such a lesion is excellent, and spontaneous regrowth often occurs. Intralesional corticosteroids, and sometimes potent topical corticosteroids, may hasten regrowth. Larger or more numerous lesions carry a more guarded prognosis. Intralesional corticosteroid injections are often begun. For extensive hair loss involving 30% to 100% of the scalp surface, a short (e.g., 3-month) course of systemic corticosteroids (usually prednisone) may be tried. If hair regrowth does not resume or if hair loss recurs once corticosteroids are stopped, the prognosis is poor. The use of systemic corticosteroids to treat extensive alopecia areata is controversial. Appropriate risk-versus-benefit considerations must be carefully analyzed.


Although spontaneous regrowth may occur even in alopecia totalis, no therapy has been found to be consistently safe and effective for severe disease. For now, topical immunotherapy with chemicals causing allergic contact dermatitis (e.g., diphencyprone) seems to offer the most hope.

Hordinsky M, Caramori A: Alopecia areata. In McMichael A, Hordinsky M, editors: Hair and scalp diseases, New York, 2008, Informa Healthcare, pp 91–105.