Topical therapy is often used for mild disease, for children, or as an add-on to procedures and oral medications.

Topical corticosteroids

Topical steroids are used to quiet immune inflammation around hair follicles and may help shift follicles back into an active growth phase. Early regrowth, when it occurs, is often first noticed in 6–12 weeks, with more meaningful cosmetic change typically taking several months. Common side effects include irritation, acne-like bumps, and skin thinning with prolonged use, especially on the face or in skin folds.

Minoxidil (adjunct therapy)

Minoxidil is not an immune treatment, but it can support regrowth by prolonging the hair growth phase and increasing follicle size, which is why it is sometimes used as an add-on in alopecia areata. Initial signs of regrowth may appear in 8–12 weeks, with fuller benefit often requiring 4–6 months. Side effects can include scalp irritation and unwanted hair growth on nearby skin if the medication spreads beyond the treatment area.

Anthralin (short-contact therapy)

Anthralin is thought to work by creating a controlled, mild irritant effect that shifts local immune signaling and may reduce the autoimmune attack on follicles. Regrowth is typically gradual and may take 3–6 months to become noticeable. Common side effects include skin irritation, staining of skin and clothing, and temporary discoloration of treated areas.

Procedural therapy is commonly used when alopecia areata is patchy and accessible for targeted treatment.

Intralesional corticosteroid injections

Intralesional steroid injections are frequently used for adults with patchy alopecia areata and work by delivering anti-inflammatory medication directly around affected follicles to suppress the local autoimmune response. If successful, new hair growth may be seen within 6–8 weeks, and injections are commonly repeated every 4–6 weeks during active treatment. Common side effects include temporary pain, small dents or thinning of the skin (atrophy), and visible tiny blood vessels at the injection sites.

Systemic therapy may be considered when alopecia areata is extensive, rapidly progressive, long-standing, or significantly impacting eyebrows/eyelashes and other areas.

Oral corticosteroids (short courses or pulse dosing)

Oral steroids can quickly suppress the immune flare driving active hair loss, which is why they are sometimes used for short-term control in select situations. Changes in shedding may improve within days to weeks, but regrowth often still takes months and relapse after discontinuation can occur. Common side effects include insomnia, mood changes, increased appetite, elevated blood pressure or blood sugar, and fluid retention, which limits long-term use.

Traditional immunosuppressants (methotrexate, cyclosporine)

These medications reduce immune activity involved in follicle inflammation and are sometimes used in more resistant cases or when rapid control is needed (more often with cyclosporine). Time to noticeable regrowth commonly spans 2–4 months or longer, depending on disease duration and severity. Side effects vary by medication but may include nausea and fatigue (methotrexate) or blood pressure and kidney effects (cyclosporine), along with increased infection risk, so monitoring is typically part of therapy planning.

Targeted oral therapy

Janus kinase (JAK) inhibitors are targeted oral therapies that can be used for severe alopecia areata, and the FDA-approved options for this indication include baricitinib (Olumiant) for adults, ritlecitinib (Litfulo) for adults and adolescents ages 12 years and older, and deuruxolitinib (Leqselvi) for adults. These medications are thought to work by interrupting JAK-mediated cytokine signaling that fuels the autoimmune attack on hair follicles, helping follicles re-enter and sustain an active growth cycle. Because hair cycling is slow, visible regrowth typically builds over months; early improvement may be seen within roughly 8–12 weeks in responders, with more meaningful cosmetic change commonly assessed over about 12–24+ weeks of therapy, and continued gains possible with ongoing treatment. Common side effects across this drug class include acne, headache, and upper respiratory infections, along with possible laboratory changes that may require monitoring; class safety warnings also include serious infections, malignancy risk, major cardiovascular events, and blood clots in appropriate risk groups, which is why careful selection and follow-up matter.