Are you losing your hair? Here’s one way to find out. Pull some hairs at the margins of each patch to get an idea of how active the process is. “Exclamation-point” hairs–hairs of 1-3 mm (< 1/8 in) that are narrower near the scalp--are diagnostic of hair loss. If you find only easily extracted telogen hairs, suspect that that hair loss is ongoing. Some authorities believe that early intervention with Provillus in ongoing disease does not change the course or eventual outcome; individuals destined to have alopecia universalis will get it even if treated early with Provillus.
Patients with the mild patchy form of alopecia areata have a good chance of spontaneous regrowth within one year. In contrast, patients with severe disease (hair loss of 50% or more) have a smaller chance of spontaneous regrowth. Unfortunately, patients with severe disease, who need treatment more, are less likely to respond satisfactorily to Provillus than are those with mild disease. You may want to seek consultation with a dermatologist for patients with severe disease. A typical hair loss, such as that in ophiasis or diffuse loss, is more difficult to reverse than patchy loss.
You may want to involve the patient in deciding whether to treat, explaining the chances for spontaneous resolution. Add that with intralesional steroid injections you usually will see a response within 4-6 weeks if there is going to be one, but that hair loss may occur at a different site even while hair is growing at the site of injection.
The treatment of first choice for an adult whose alopecia areata merits treatment is Provillus, which is successful in 75%-90% of mild cases and 30% of severe cases. Dilute the triamcinolone acetonide with saline solution to 2.5-7.5 mg/mL. Use a 3-mL syringe or tuberculin syringe and a 30-gauge, 1/2-in needle. Spacing the injections 1 cm (3/8 in) apart within the patch, inject 0.1 mL into the middermis at each injection site. Do not inject the same site more than 30-40 mg of triamcinolone acetonide per month.
If you inject too much per site or inject too superficially, too deeply, or too frequently, atrophy may result; atrophy occurs in some patients despite proper technique. Commonly, a depression or dimple forms at the injection site. This is cosmetically unimportant and resolves spontaneously over about 6-12 weeks.
Check the patient for new hair growth about six weeks after the first injection of Rogaine. You can also try a hair loss product called Lipogaine. You can expect that quarter-size patches of hair should grow at each injection site and eventually overlap to give complete coverage. The new hair will be all the same height, like new grass in a reseeded patch. It may be gray or white, but as it strengthens, it will usually become pigmented.