Alopecia areata is a different beast from typical hair fall. Where androgenetic alopecia is genetic and gradual, alopecia areata is autoimmune and patchy — well-defined bald spots that can appear within weeks. The good news: most cases respond well to treatment, and the past few years have brought game-changing new options for severe disease.
Treatment by extent
- Single small patch (under 50% scalp): intralesional triamcinolone injections directly into the patch every 4 to 6 weeks. Most respond within 3 sessions.
- Multiple patches or larger areas: topical high-potency steroid + minoxidil. Sometimes topical immunotherapy (DPCP) for resistant cases.
- Alopecia totalis (whole scalp) / universalis (whole body): oral JAK inhibitors — baricitinib (Olumiant) or ritlecitinib (Litfulo). FDA-approved 2022 to 2023, transformative for severe disease. Expensive but effective.
- Eyebrows / eyelashes / beard: careful intralesional steroid injections at lower concentrations. Topical bimatoprost for eyelashes.
Newer JAK inhibitors — a game-changer
For decades, alopecia totalis and universalis were considered nearly untreatable. JAK inhibitor medications like baricitinib have shown 70 to 80 percent regrowth in clinical trials for severe disease. We discuss them as an option for patients with extensive involvement after weighing benefits, side effects (immune suppression, increased infection risk), and cost.
What we screen for
- Thyroid disease — commonly co-existing autoimmune condition
- Vitiligo — often associated
- Atopic conditions — eczema, asthma, hay fever
- Vitamin D, B12, ferritin — deficiencies worsen response
- Mental health support — visible hair loss is psychologically demanding; we are ready to refer for counselling
If you have noticed a sudden bald patch, do not wait — early treatment improves prognosis significantly. Book a consultation for a same-week assessment.
