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Not treating is a common option

Alopecia areata is a very unpredictable condition. In many cases, bald patches re-grow by themselves without treatment. In particular, if there are just one or two small bald patches then many doctors would advise that you simply leave it alone at first. This is sometimes called ‘watchful waiting’. If the hair loss is not too bad then there is a good chance that hair will re-grow after several months. (Any re-growth usually does not start within three months of hair loss.) A change in hair style may perhaps conceal one or two small bald patches. If the hair loss becomes more extensive, then the decision on whether to treat can be reconsidered. But even with extensive hair loss, there is still a chance that hair will re-grow without treatment.

Note: alopecia areata itself won’t damage your general health and so not treating will not lead to any general health problems. When deciding on whether to treat or not, you should take into account the possible side-effects that some of the treatments may have. Also, treatments promote hair to re-grow and do not affect or ‘cure’ the underlying cause of the condition.

Steroid injections

Injections of steroid into the bald patches of the scalp suppresses the local immune reaction that occurs in alopecia areata. This can then allow the hair follicles to function normally again and for hair to re-grow. This treatment may be an option for one or more small to medium sized bald patches. Steroid injections are thought to be the most effective treatment for patches of alopecia areata that are not too big. However, they do not work in every case.

This treatment is usually only done by a skin specialist and so you will usually need to be referred to hospital for it. Several injections (about 1 cm apart) are usually given at each session of treatment but the number is often limited by pain. Therefore, large bald areas are not suitable for steroid injections. Initial re-growth takes 1-2 months and injections are repeated every 4-6 weeks.

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