Alopecia areata

Many small patches regrow on their own, so some people and clinicians choose to monitor for a time with photos and regular check-ins rather than treat right away.

Often considered when patches are few and small, the person is not very bothered, or the hair loss is recent and may still settle.

Less suitable when hair loss is spreading fast, is affecting mood or daily life, or the diagnosis is uncertain.

Patches that grow, new patches, nail changes, or distress about appearance.

Often several months, since regrowth and new loss can both happen without treatment.

• What signs would tell us to treat sooner instead of waiting?
• How often should I be rechecked?
• Are my nail changes related to this?

Cover-up options include wigs, hairpieces, scarves, hats, hair fibers or powders, scalp tattooing (micropigmentation), and eyebrow pencils, microblading, or false lashes. Areas without hair have less natural protection from the sun.

Often considered when someone wants to feel more comfortable in public, while waiting to see if hair regrows, or when treatment is not wanted or not working.

Less suitable if the skin is irritated or broken, or if adhesives or dyes have caused a reaction before. Tight styles, glues, or heavy attachments can pull on hair and may not suit sensitive areas.

Itching, redness, or rash under wigs, tape, or glue. Sunburn on exposed scalp, which can be harder to notice on deeper skin tones. Eye irritation from lash products.

Immediate for cover-ups. Sun protection matters at any time with exposed scalp.

• Which cover-up options are gentle on my scalp?
• How should I protect my exposed scalp from the sun?
• Is scalp micropigmentation or lash or brow tattooing reasonable for me?

A topical product, sold over the counter in many countries, that is applied to the scalp, brows, or beard. It is not an immune treatment, but it may help hair grow where follicles are still active.

Often considered as an add-on to other treatments, since on its own it is less likely to help much in this condition.

Less suitable if it has irritated the skin before or if there is a known allergy to its ingredients. Ask a clinician first about use in pregnancy or breastfeeding, and keep it away from pets, which can be harmed by it.

Scalp irritation, itching, dryness, unwanted hair growth on nearby skin, and extra shedding early on.

Usually several months before a judgment can be made.

• Could minoxidil add anything to my plan?
• Is it safe to combine with my other treatments?
• What should I do if my scalp gets irritated?

Prescription steroid creams, foams, lotions, or ointments applied to patches to calm the local immune attack on follicles.

Often considered for limited patches, and sometimes for children or people who prefer to avoid injections.

Less suitable on broken or infected skin, near the eyes without a clinician's guidance, or when long-term use on large areas is a concern.

Skin thinning, stretch marks, folliculitis (small pimple-like bumps), and lightening of the skin, which may be more noticeable on brown and Black skin.

Clinicians often judge response after about three months or more, since hair grows slowly.

• Is a topical steroid reasonable for my pattern?
• What skin changes should I watch for?
• How will we decide whether it is working?

A clinician injects a small amount of steroid into the skin of a patch with a fine needle to calm the immune activity near the follicles.

Often considered for a few patches on the scalp, eyebrows, or beard in older children and adults.

Less suitable for very extensive hair loss, for young children who may not tolerate injections, or when there is infection in the area.

Pain at the time of injection, small dents or thinning of the skin, and lightening of the skin, which may be more visible on brown and Black skin. New patches may still appear elsewhere.

New hair often takes about one to three months to show. Treatment is usually repeated by the clinician over time, and hair can fall out again.

• Am I a good candidate for injections?
• What are the chances of skin dents or color change for me?
• What happens if hair falls out again?

A specialist applies a chemical, such as diphenylcyclopropenone (DPCP) or squaric acid, to the scalp to cause a mild, controlled allergic skin reaction. The goal is to redirect immune cells away from the follicles.

Often considered for widespread or long-lasting patchy hair loss, sometimes when other treatments have not helped.

Less suitable in pregnancy or breastfeeding, for people who cannot manage repeated visits or home precautions, or when the skin reaction would be too hard to tolerate.

Itching, redness, blistering, swollen glands in the neck, hives, and changes in skin color, which can be more noticeable on brown and Black skin. The treated area is sensitive to sunlight and the chemical must be kept off other skin and other people.

Often many months of regular treatment before a judgment, and hair can fall out again after stopping.

• Is this available near me, and who offers it?
• What reaction is expected and what is too much?
• How would we know it is not working?

Prescription pills that block certain immune signals (called Janus kinase, or JAK) involved in this condition. As of October 2026, the U.S. FDA has approved three for severe alopecia areata: baricitinib (Olumiant) and ritlecitinib (Litfulo), both for people 12 years and older, and deuruxolitinib (Leqselvi), for adults.

Often considered for severe or extensive hair loss, such as loss of half or more of scalp hair, when it affects quality of life and other options have not been enough.

Less suitable with active or recurrent serious infections, tuberculosis or hepatitis exposure, certain cancers, a history of blood clots, heart disease, or heavy smoking, and during pregnancy or breastfeeding. They are not meant to be combined with other JAK inhibitors or strong immune-suppressing medicines. Some have extra restrictions, such as drug interactions or genetic testing.

These medicines carry a boxed warning, the FDA's strongest type, about serious infections, death, cancer, heart problems, and blood clots. Clinicians usually check blood tests and screening before and during treatment. Other effects can include acne, headache, and cold-like infections.

Regrowth usually takes months, often six months or longer. Hair loss often returns if the medicine is stopped, so long-term planning is part of the decision.

• Am I a candidate, and what screening would I need?
• What are the benefits and risks for my age, health, and family history?
• What happens to my hair if I stop, and what does it cost with my insurance?

Short courses of steroid pills, or other medicines that calm the immune system, are sometimes used for fast-spreading or severe cases. Light therapy is another option some clinics offer.

Often considered when hair loss is advancing quickly or when the usual options are not suitable or have not helped.

Less suitable for long-term use because of side effects, and in pregnancy, active infection, or certain other health conditions. Hair loss often returns when steroid pills stop.

Steroid pills can affect mood, sleep, weight, blood sugar, blood pressure, and bones. Other immune medicines need regular blood tests.

Varies by medicine, usually a few months to judge.

• Are any of these reasonable for me, and why or why not?
• What monitoring would I need?
• What is the plan if hair falls out again after stopping?

Support groups, peer mentors, and counseling or therapy for the emotional side of hair loss, including worry about relapse and changes in how a person feels about their appearance.

Often considered for anyone who feels sad, anxious, embarrassed, or isolated, and for children and teens dealing with comments from others.

Rarely unsuitable. If someone has thoughts of self-harm, urgent help is needed rather than waiting for a routine visit.

Not every group or counselor is a good fit, and it can take trying more than one.

Benefits can be felt within weeks, and support can continue whether or not hair regrows.

• Can you recommend a counselor or support group familiar with hair loss?
• How can I support my child at school?
• How do I cope with the worry that hair loss will return?