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How Is It Treated?
While there is neither a cure
for alopecia areata nor drugs approved for its treatment, some people find
that medications approved for other purposes can help hair grow back, at
least temporarily. The following are some treatments for alopecia areata.
Keep in mind that while these treatments may promote hair growth, none of
them prevent new patches or actually cure the underlying disease. Consult
your health care professional about the best option for you.
- Corticosteroids--Corticosteroids
are powerful anti-inflammatory drugs similar to a hormone called cortisol
produced in the body. Because these drugs suppress the immune system if
given orally, they are often used in the treatment of various autoimmune
diseases, including alopecia areata. Corticosteroids may be administered
in three ways for alopecia areata:
- Local injections--Injections
of steroids directly into hairless patches on the scalp and sometimes
the brow and beard areas are effective in increasing hair growth in most
people. It usually takes about 4 weeks for new hair growth to become
visible. Injections deliver small amounts of cortisone to affected
areas, avoiding the more serious side effects encountered with long-term
oral use. The main side effects of injections are transient pain, mild
swelling, and sometimes changes in pigmentation, as well as small
indentations in the skin that go away when injections are stopped.
Because injections can be painful, they may not be the preferred
treatment for children. After 1 or 2 months, new hair growth usually
becomes visible, and the injections usually have to be repeated monthly.
The cortisone removes the confused immune cells and allows the hair to
grow. Large areas cannot be treated, however, because the discomfort and
the amount of medicine become too great and can result in side effects
similar to those of the oral regimen.
- Oral corticosteroids--Corticosteroids
taken by mouth are a mainstay of treatment for many autoimmune diseases
and may be used in more extensive alopecia areata. But because of the
risk of side effects of oral corticosteroids, such as hypertension and
cataracts, they are used only occasionally for alopecia areata and for
shorter periods of time.
- Topical ointments--Ointments
or creams containing steroids rubbed directly onto the affected area are
less traumatic than injections and, therefore, are sometimes preferred
for children. However, corticosteroid ointments and creams alone are
less effective than injections; they work best when combined with other
topical treatments, such as minoxidil or anthralin.
- Minoxidil (5%)
(Rogaine*)--Topical minoxidil solution promotes hair growth in several
conditions in which the hair follicle is small and not growing to its full
potential. Minoxidil is FDA-approved for treating male and female pattern
hair loss. It may also be useful in promoting hair growth in alopecia
areata. The solution, applied twice daily, has been shown to promote hair
growth in both adults and children, and may be used on the scalp, brow,
and beard areas. With regular and proper use of the solution, new hair
growth appears in about 12 weeks.
*Brand names included in this booklet are provided as
examples only, and their inclusion does not mean that these products are
endorsed by the National Institutes of Health or any other Government
agency. Also, if a particular brand name is not mentioned, this does not
mean or imply that the product is unsatisfactory.
- Anthralin (Psoriatec)--Anthralin,
a synthetic tar-like substance that alters immune function in the affected
skin, is an approved treatment for psoriasis. Anthralin is also commonly
used to treat alopecia areata. Anthralin is applied for 20 to 60 minutes
("short contact therapy") to avoid skin irritation, which is not needed
for the drug to work. When it works, new hair growth is usually evident in
8 to 12 weeks. Anthralin is often used in combination with other
treatments, such as corticosteroid injections or minoxidil, for improved
results.
- Sulfasalazine--A sulfa
drug, sulfasalazine has been used as a treatment for different autoimmune
disorders, including psoriasis. It acts on the immune system and has been
used to some effect in patients with severe alopecia areata.
- Topical sensitizers--Topical
sensitizers are medications that, when applied to the scalp, provoke an
allergic reaction that leads to itching, scaling, and eventually hair
growth. If the medication works, new hair growth is usually established in
3 to 12 months. Two topical sensitizers are used in alopecia areata:
squaric acid dibutyl ester (SADBE) and diphenylcyclopropenone (DPCP).
Their safety and consistency of formula are currently under review.
- Oral cyclosporine--Originally
developed to keep people's immune systems from rejecting transplanted
organs, oral cyclosporine is sometimes used to suppress the immune system
response in psoriasis and other immune-mediated skin conditions. But
suppressing the immune system can also cause problems, including an
increased risk of serious infection and possibly skin cancer. Although
oral cyclosporine may regrow hair in alopecia areata, it does not turn the
disease off. Most doctors feel the dangers of the drug outweigh its
benefits for alopecia areata.
- Photochemotherapy--In
photochemotherapy, a treatment used most commonly for psoriasis, a person
is given a light-sensitive drug called a psoralen either orally or
topically and then exposed to an ultraviolet light source. This combined
treatment is called PUVA. In clinical trials, approximately 55 percent of
people achieve cosmetically acceptable hair growth using photochemotherapy.
However, the relapse rate is high, and patients must go to a treatment
center where the equipment is available at least two to three times per
week. Furthermore, the treatment carries the risk of developing skin
cancer.
- Alternative therapies--When
drug treatments fail to bring sufficient hair regrowth, some people turn
to alternative therapies. Alternatives purported to help alopecia areata
include acupuncture, aroma therapy, evening primrose oil, zinc and vitamin
supplements, and Chinese herbs. Because many alternative therapies are not
backed by clinical trials, they may or may not be effective for regrowing
hair. In fact, some may actually make hair loss worse. Furthermore, just
because these therapies are natural does not mean that they are safe. As
with any therapy, it is best to discuss these treatments with your doctor
before you try them.
In addition to treatments to
help hair grow, there are measures that can be taken to minimize the
physical dangers or discomforts of lost hair.
- Sunscreens are important for the scalp,
face, and all exposed areas.
- Eyeglasses (or sunglasses) protect the
eyes from excessive sun, and from dust and debris, when eyebrows or
eyelashes are missing.
- Wigs, caps, or scarves protect the scalp
from the sun and keep the head warm.
- Antibiotic ointment applied inside the
nostrils helps to protect against organisms invading the nose when nostril
hair is missing.
Copyright Notice:
Reprinted with permission from:
National Institute of Arthritis
and Musculoskeletal
and Skin Diseases (NIAMS)
NIAMS/National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
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