In many cases, because alopecia areata is so unpredictable, many allow the bald patches to re-grow by themselves without treatment. Typically, if it’s just one or two small bald patches, doctors advise that you leave it alone. Sometimes this is referred to as watchful waiting. If the hair loss is not too bad, there is a good chance that it will re-grow after several months. Sometimes a simple change in the hairstyle will conceal one or two bald patches. If the hair loss becomes more extreme, a decision will probably be made as to whether treatment should be considered.

Something to note; alopecia areata won’t damage your general health so not treating will not lead to any general health problems. You need to be aware of possible side - effects that some of the treatments may have. Also, treatments promoting hair re-growth do not affect or “cure” the underlying cause of alopecia.

One treatment would be steroid injections. The theory here is that injecting steriods into the bald patches of the scalp supresses the local immune reaction that occurs in the alopecia areata. This can then allow the hair follicles to function normally again and for the hair to re-grow. A word of caution about this treatment. First of all, it does not work for everyone, and secondly, I am aware of a couple of people that had these injections for years and today have digestive/internal issues as a result.

Another treatment is topical or rub on steroid cream or gel. It does not work as well as the injections but it could certainly be worth a try.

Another treatment is topical immunotherapy which seems to be the most effective option for people with extensive alopecia areata. This treatment is only done by some skin specialist to you will need a referral from a doctor. With topical immunotherapy a substance is put on the affected skin to make the skin react like an allergy. Increasing strengths of this substance are placed on the affected skin once a week over several weeks until the skin looks like it has a mild case of eczema. The skin reaction seems to affect the process involved in causing alopecia areata in some way to allow hair to re-grow. Side effects from this treatment can be troublesome. For example, some people develop severe skin reactions. Treating children with topical immunotherapy is controversial. In a large study done with people having this treatment, 3 in 10 cases had good hair growth after six months. In 32 months, 8 in 10 cases has good regrowth. Regular maintenance treatment is needed to keep the hair loss from returning.

There is another treatment with a drug, Dithranol. It is thought to be less effective than topical immunotherapy but works in some cases. It is applied daily to the whold scalp and left for 20-60 minutes before it is washed off. One study showed that it helps hair re-growth in about 1 in 4 cases. Again, there are side effects such as itchiness, redness and scaling are the most common. Dithranol is not widely used for alopecia because it is so messy to use.

Other treatments may include:

• Special light therapy or phototherapy.
• Immunosuppressant medicine called ciclosporin. Again, side effects are an issue and hair loss often recurs when the medication is stopped.
• Dermatography (tattooing) is used to simulate eyebrows that have fallen out.
• Counselling is sometimes helpful for people who find coping with the disease difficult.
• Sun block or a hat should be worn to protect bald patches when out in the sun.
• There are complementary treatments such as acupuncture and aromatherapy but not enough evidence exists to determine how effective these treatments are in treating alopecia.

Wigs are probably the most common treatment choice for people with alopecia areata. Sometimes this is just easier than dealing with drugs and side effects.