What are the New Treatments for Alopecia

According to the National Alopecia Areata Foundation, 160 million people worldwide will experience alopecia areata in their lifetime – with nearly 6.7 million people in the U.S. alone.

Not only does unexpected hair loss have a cosmetic impact, but sufferers often develop mental health issues, including depression, anxiety, and social phobias. However, not all current treatments work, especially for severe forms of alopecia.

As such, the scientific community is researching various new interventions that may offer patients some much-needed hope.

What is alopecia?

Alopecia results in hair loss on the scalp and/or body due to an unusual immune system response. While anyone can develop alopecia, most people get it in their teens, 20s, or 30s, and people with alopecia have a 20% chance of another family member having the condition. Based on this, experts believe that there is a genetic predisposition for developing the disease.

The three main types of alopecia are:

• Alopecia areata, which is the most common, and results in small, round bald patches on the scalp or body
• Alopecia totalis, which causes the scalp to become completely bald
• Alopecia universalis, which results in complete hair loss all over the body, including the eyelashes, eyebrows, nose, and ear hair

Some patients may experience hair regrowth without medical interventions, while many will need to consult a healthcare professional to get an adequate form of treatment.

What causes alopecia?

Alopecia occurs when the immune system attacks the body’s hair follicles, which results in inflammation and hair loss. Although researchers don’t fully understand why this happens, several genetic and environmental factors appear to contribute – including severe infections, emotional stress, hormone changes, and some medications.

What treatments are already available for alopecia?

There are several existing treatments for alopecia, each with varying success rates. What works for one person might not work for another. However, a medical professional will be able to advise you on the best course of action, taking your unique circumstances into account.

Topical corticosteroids

Most patients with patchy alopecia will be given a topical corticosteroid to address the inflammation, which must be used for at least three months before any results begin to appear. This approach is widely recommended for children as it’s both painless and safe.

One study of topical corticosteroids for alopecia areata demonstrated up to 70% hair regrowth after three months for one particular group of patients. However, they’re generally regarded as having limited benefits.

Intralesional corticosteroids

Intralesional corticosteroids are another common treatment for alopecia, particularly in conditions impacting less than half of the scalp. Hydrocortisone acetate and triamcinolone acetonide are most frequently used.

The solution is carefully injected in or just beneath the dermis at 1 cm intervals across the scalp, with lower concentrations of the active ingredients used on the eyebrows and face if needed. This is repeated every four to six weeks.

One study of intralesional corticosteroids for alopecia demonstrated a 47% regrowth at 12 weeks and a 95% regrowth at 24 weeks when it was administered at four week intervals. However, severe types of alopecia – such as alopecia totalis and alopecia universalis – don’t usually respond well to this treatment.

Many patients experience skin atrophy at the injection site as a common side effect, although this often dissipates a few months after the treatment has finished.

Anthralin

Anthralin (dithranol) has been proven to be effective in some cases of alopecia. One study of anthralin for alopecia showed 25 % of patients experienced more than 90% regrowth, and 39.5% of patients experienced 50%–90% regrowth.

The immunotherapeutic agent is understood to have anti-inflammatory and immunosuppressant properties, although how it works isn’t completely understood.

Patients apply the solution directly to the scalp every other day to begin with, then daily once the skin has become used to it. The area is then washed with shampoo 20–30 minutes later to help avoid irritation.

However, some people may still experience side effects, such as scaling, skin staining, folliculitis, pruritus, erythema, and regional lymphadenopathy.

Topical minoxidil

Minoxidil is a topical medication that is generally used as a complementary treatment for less severe alopecia. It works by improving blood flow, nutrient supply, and follicle health to both reduce hair loss, and promote regrowth.

Results can sometimes be seen within three months, but it will only have a significant impact with continued use. One study about minoxidil for alopecia indicated that it was effective in 81% of people with patchy alopecia, but it is unlikely to have an impact in more severe cases.

Side effects include dermatitis, hypertrichosis, and headaches, although these symptoms should be alleviated once the treatment has finished.

Not seeing the results you hoped for with Minoxidil? Discover why it might not be working as expected and what you can do about it in our detailed guide.

Minoxidil Not Working? Reasons Why & What To Do

Topical retinoids

Although retionoids such as retinoin and bexarotene have been used for alopecia, they’ve had varying results, and they pose the risk of skin irritation in many patients.

One study about retinoids for alopecia, which involved applying bexarotene gel for six months, resulted in 12% of patients having at least 50% hair regrowth. However, the results were inconclusive in some of the other participants.

Oral Janus kinase inhibitors

Janus kinase (JAK) inhibitors are oral drugs that can impact various immunological pathways. JAKs are protein messengers that promote the attack on the hair follicles. By blocking their signals, fewer cytokines are produced, resulting in less inflammation and more hair regrowth. They are shown to be safe and effective in studies for other inflammatory conditions such as psoriatic arthritis and rheumatoid arthritis, and have helped some people with alopecia.

Whilst there's limited evidence to support their success, further clinical research is being undertaken and new types of JAK inhibitors have come onto the market, which we’ll look at in more detail later.

Platelet-rich plasma

Injections of platelet-rich plasma (PRP) are a relatively recent and safe option for treating hair loss, sometimes used to complement other approaches, including hair transplantation.

As with most treatments, however, the impacts of PRP injections vary considerably in different patients and usually have minimal benefits for people with more severe cases of alopecia. The procedure itself can also be painful.

Systemic corticosteroids

The progress of alopecia may be interrupted by systemic steroids in some people. One study of systemic corticosteroids and alopecia demonstrated 71.43% hair regrowth. However, there are also many contradictory reports indicating that it delivers minimal results.

Azathioprine

Azathioprine is an oral medication that suppresses the immune system and has shown some positive results for treating alopecia. One such study of azathioprine for treating alopecia demonstrated improvements in moderate to severe alopecia areata.

Cyclosporine

Cyclosporine is a drug with immunosuppressive and hypertrichotic properties. It’s usually used to treat severe cases of alopecia that have failed to respond to other treatments. A systematic review of cyclosporine for alopecia showed a 66% response rate in the sample when used for an average duration of 5.77 months.

Methotrexate

Methotrexate is an immunosuppressant medicine that when used alone, or with prednisolone, can be an effective treatment. One study of methotrexate and alopecia demonstrated hair regrowth in 63.2% of patients receiving the drug, but the results of other studies vary.

Sulfasalazine

Sulfasalazine is a medication with immunomodulatory and immunosuppressive properties, which can be effective in some people. A medical professional will start you on a low dose which is gradually increased over time.

Photochemotherapy

Various types of psoralen and ultraviolet-A light therapy can be used to treat alopecia, and are often used in conjunction with other treatments. One study of photochemotherapy for alopecia demonstrated that 11 of 17 patients who combined oral methoxsalen and total body irradiation experienced either complete or over 90% hair regrowth.

Excimer laser and excimer light

Excimer laser and excimer light therapies deliver UV light to the scalp to promote follicle health, stimulate growth, and suppress the autoimmune response. Studies of excimer laser and excimer light for alopecia have demonstrated positive results, and erythema of the skin has been the only known side effect.

What are the new treatments for alopecia?

Researchers have been striving to gain a better understanding of alopecia so they can develop more effective ways of treating it. This has resulted in two new medications known as Olumiant (baricitinib) and Litfulo (ritlecitinib).

Olumiant (baricitinib)

In June 2022, the FDA approved Olumiant (baricitinib) for the treatment of severe alopecia in adults – the first oral drug to be specifically approved for treating the condition. Olumiant (baricitinib) is a janus kinase (JAK) inhibitor taken in tablet form once a day.

Clinical trials of baricitinib for severe alopecia showed ​​that 32% to 35% of patients experienced hair regrowth covering 80% or more of their scalp after 36 weeks of treatment. This improved over time, with 90% of patients having an 80% coverage after using baricitinib for two years.

Litfulo (ritlecitinib)

In 2023, the FDA went on to approve a new drug ritlecitinib sold under the brand name, Litfulo. Litfulo is also a JAK inhibitor, taken once a day in capsule form. This is the first medication to be approved for adolescents as young as 12 who are suffering with severe alopecia.

A clinical trial studying ritlecitinib for alopecia assessed 718 patients who had 50% or more scalp hair loss. The study showed that it was effective in achieving hair regrowth to 80% or more scalp.

This is a huge breakthrough for the thousands of young people whose lives are impacted by this unpleasant condition.

Alternative and off-label treatments for alopecia

Alternative treatments are often used by people with alopecia – some of which are proven to help, and others with no medical backing or supporting data. They include Xeljanz (tofacitinib), Vitamin D, anthralin, acupuncture, aromatherapy with essential oils, topical melatonin, onion juice, and garlic extract.

Always do your research, and consult a medical professional before you try new or alternative treatments to ensure they’re safe.

What do future alopecia treatments look like?

Scientists are continuing their research into the causes of alopecia so they can find more effective ways of treating it. Currently, there are hundreds of clinical trials investigating the impacts of medications and other therapies for alopecia, as well as for other dermatological conditions.

The microbiome

Scientists are studying the microbiome, and in particular, its role in autoimmunity in relation to fecal transplants.

Studies into scalp bacterial shifts in alopecia areata discovered that two patients with alopecia experienced hair regrowth after receiving a fecal transplant aimed at treating clostridium difficile bacteria.

This has opened up the possibility that by restoring the gut microbiota balance, fecal microbiota transplants – which involve transferring fecal bacteria and other microbes from a healthy person into another individual – could be a therapy for alopecia.

Human cells

Studies of stem cell therapy for hair loss indicate that this treatment could potentially be used for alopecia.

After harvesting stem cells from a patient’s body, they’re activated to produce a reaction that creates specialized cells that can replace missing or damaged hairs. They’re then injected into the scalp, and when they become active, they produce new follicles and help hair to regrow.

‘Blood-mesenchymal stromal cells’ taken from the human umbilical cord are also believed to promote hair follicle growth and health.

Fractional photothermolysis

This laser technique stimulates a wound-healing environment in the reticular dermis. So far, clinical results for fractional photothermolysis for alopecia show that when it’s combined with topical corticosteroids, it has excellent results and minimal side effects.

Tralokinumab

Tralokinumab is what’s known as a ‘monoclonal antibody’ and is already used to treat atopic dermatitis. One study testing tralokinumab alopecia showed that with daily use, it was effective in most participants with moderate to severe atopic dermatitis.

Gene therapy

In androgenetic alopecia, which is caused by genetics, the hair follicles are sensitive to dihydrotestosterone (DHT). It’s thought that gene therapy could change these hair follicles into DHT-resistant cells so they can then grow new hairs. One study of gene therapy in alopecia shows promising results, with clinical research leading to new treatment opportunities and approaches.

How to get involved in a clinical trial for alopecia

By getting involved in a clinical trial for alopecia, you can access new and innovative medical interventions, and help the scientific community find effective, long-term treatments. You can find a clinical trial by searching online databases, talking to a healthcare professional, or asking members of alopecia support groups.

You may also want to learn more about how to volunteer in clinical trials and the important questions you should ask before taking part in a clinical trial.

Conclusion

Although alopecia impacts millions of people, a lot is yet to be discovered about the disease and how it’s caused. Many different treatments are currently available, with two new medicines coming onto the market in very recent years.

Scientists are also exploring more innovative interventions as clinical trials are an essential part of the research process, playing a pivotal role in potentially ending the suffering this condition causes.