Alopecia Areata: Causes, Treatments, Costs

Mike Kaine, MD

This text was written according to the highest scientific standards and reviewed by medical experts. Find out more about our quality assurance.

Written by Erin D. Updated on 14 Jan 2024

Alopecia Areata refers to a form of inflammatory hair loss. The causes are largely unknown, although many people are affected by this particular form of hair loss. With alopecia areata, the hair falls out in a circular shape and the areas continue to spread from the center of the bald patch. As a rule, not a single hair remains in the bald patches. Find out all about the causes, effective treatments and what you should avoid in this guide.

Causes and symptoms of alopecia areata

Exactly why alopecia areata occurs is largely unexplored. Experts assume that the disease is caused by an incorrect reaction of the immune system. The immune system fights its own hair instead of viruses and bacteria, which in turn leads to inflammation at the root of the hair. The inflammation disrupts hair growth and eventually the hair falls out. Alopecia Areata is therefore an autoimmune disease and often occurs in conjunction with other autoimmune diseases such as white spot disease or thyroid disorders. Children and young adults are particularly frequently affected. A study in the USA also found that girls are affected more frequently than boys. A hereditary predisposition is currently being researched, as there are known cases of families in which the disease occurs more frequently.


Hair loss symptoms


The symptoms of alopecia are round, hairless patches on the scalp or other parts of the body. Short, broken hairs usually remain at the edge of the patch, which become thinner towards the hair root. In most cases, the hair grows back on its own within a year, but the disease can return. In severe cases, however, the bald patches can grow together and lead to complete hair loss on the head (alopecia areata totalis) or even the whole body (alopecia areata universalis). This severe form of alopecia areata is often persistent. However, there are some treatment methods to stop hair loss at an early stage, which we would like to introduce to you here.

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How can Alopecia Areata be treated?

There are several ways to treat alopecia areata. However, success can often only be achieved with a combination of different treatment methods. You should therefore consult a specialist as soon as you notice the first signs in order to find the right treatment for you.

Treatment with Glucocorticoids

The most common form of treatment for alopecia areata is with locally applied glucocorticoids such as cortisone, which suppress the immune response and allow the hair follicle to regenerate. These medications usually work very well during application, but hair loss may continue after discontinuation.

In addition to local treatment with creams, it is also possible to inject the active ingredient under the skin, which also treats deeper layers of the skin. Even if the result is generally better, local therapy is usually used first.

In a severe form of alopecia areata, systemic glucocorticoids (e.g. prednisolone) or immunosuppressants may be prescribed. However, due to the severe side effects of these preparations (e.g. a weakened immune system, weight gain, oedema of the legs, a swollen face), their use should be carefully considered beforehand.

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Topical Immunotherapy

Another form of treatment is topical immunotherapy, which is usually used for persistent cases when cortisone is ineffective.

Topical immunotherapy involves treatment with the Contact Allergen Diphenylcyclopropenone (DCP). This is intended to stimulate the immune system and stop hair loss. The medication has not yet been approved and is only offered in specialized centers or university clinics.

Even though studies show that hair loss is stopped in around two thirds of patients, it should only be taken after consultation in a special center, as side effects can occur. Pregnant women or women who wish to have children should definitely refrain from treatment with DCP, as the medication is dangerous for the unborn child.

Hair transplantation for Alopecia Areata

Unfortunately, hair transplants should be avoided in alopecia areata, as the transplanted hair follicles can also be attacked by the immune system and would therefore fall out again.

Experimental hair transplants for alopecia areata have been carried out in a few studies. The results of these studies show that in most cases the circular hair loss reoccurs or the result could only be maintained by regular cortisone injections over a long period of time. We therefore advise against hair transplantation for this disease and recommend one of the other forms of treatment.

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Finasteride and Minoxidil

According to Stiftung Warentest, finasteride and minoxidil are two active ingredients that have a limited effect against hair loss.

Finasteride is only available on prescription and is actually used to treat prostate hyperplasia. The drug should also not be used in pregnant women or women who wish to have children, as it can damage the reproductive organs of male foetuses. Finasteride can prevent the death of dihydrotestosterone-sensitive hair follicles and thus stop hair loss. The prerequisite is that the hair follicles have not yet died. Treatment with finasteride is therefore only recommended in the early stages of circular hair loss.

How do minoxidil and finasteride work?

The active ingredient minoxidil is applied externally and there are different products with different concentrations for men and women. For men there is a foam and a 5% solution, while a 2% solution is used for women. Minoxidil is an antihypertensive, but how the drug promotes hair growth is still unknown. Studies from the 1980s found that 50% of those treated showed visible improvements. The application is somewhat complicated, as the treated areas must be covered airtight overnight. In women, higher doses may result in more facial hair, which should also be considered.

Finasteride and minoxidil have in common that the active ingredients only work against circular hair loss as long as they are used. If the active ingredient is discontinued, the hair loss usually continues.

Experimental Treatment Options

Other hair loss treatment methods have already been tested in studies, but have not yet been sufficiently proven by studies to generally recommend them.

Laser, conventional immune-suppressing medication Dithranol and a psolar UVA turban have already been tested. With the psolar UVA turban, the hairless areas are wrapped for several minutes with a cloth soaked in a special solution to make the skin more sensitive to light on contact. The head is then irradiated with long-wave ultraviolet rays without the turban.

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The level of suffering of those affected by alopecia areata is relatively high, so many hope for a quick cure. Unfortunately, there is no single treatment method that will achieve a quick cure.

A visit to a specialist who recommends a combination of different treatment methods has the best chance of success. The good news is that in most cases the disease heals spontaneously and the hair grows back. In many cases, a hair system can also be useful for the transition phase.

Frequently Asked Questions

What is Alopecia Areata?

What is the cause of Alopecia Areata?

How is Alopecia Areata treated?



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