Background and General Recommendations 

• “Alopecia” is an umbrella term meaning hair loss. Alopecia Areata is an autoimmune form of hair loss in which your immune cells are attacking your hair follicles.  
• Usually just one or a few bald patches on the scalp but sometimes the entire scalp or entire body can be affected. If your case is just one or a few spots, it usually resolves on its own and subsequent recurrences are usually just as localized. If you feel like it is spreading let me know. FYI, when the hairs grow back, they often come in white at first before they regain their color. 
• We have ways to effectively treat areata but there is no cure.   

Workup and Treatment options  

• Labs: CBC, CMP, thyroid function tests, iron panel, ferritin, vitamin D level 
• Topical steroid – Apply to the bald spot(s) once daily until hair is growing back throughout the entire bald spot. 
• Steroid injections – A lot of needle pokes but works well because it delivers the steroid a little deeper than a cream. Repeat monthly until hair is growing back.  
• Doxycycline – Anti-inflammatory medication. Potential side effects include sun sensitivity (wear sunscreen), upset stomach (taking with food helps), heartburn (take with food or a full glass of water, don’t take right before bed). Don’t take with dairy products or antacids. Consider taking a probiotic while using. Yeast infections can occur.   

• Topical immunotherapy with squaric acid or DPCP – The purpose of these is to induce a mild contact eczema to “distract” your immune system. I do the first application in the clinic to sensitize you and then prescribe you a weaker version that you can use