Alopecia Drug Summary

Last updated: 03 March 2026
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Corticosteroid Hormones*

Drug Available
Strength		 Dosage Remarks
Intralesional Injections
Dexamethasone 5 mg/mL injection 0.2-6 mg intralesionally repeated every 3-5 days or 2-3 weeks Adverse Reactions
  • Skin atrophy which may be minimized by injecting small volumes and only into the mid-dermis
Special Instructions
  • Preferred application is using 3 mL syringe with 30-gauge ½-inch long needle
  • Topical anesthesia may be used
  • Do not raise wheal or inject into SC tissue
  • If skin atrophy occurs, site should not be re-injected until atrophy resolves
  • Do not inject solution into fat or epidermis
Triamcinolone
acetonide		 10 mg/mL injection Scalp: Inject 2.5-5 mg into mid-dermis at multiple sites 1 cm apart
Repeat every 4-6 weeks
Max dose - scalp: 20 mg/visit
Eyebrows: 1.25 mg injection into the mid-dermis of each brow divided into 5-6 sites
Max dose - beard: 7.5 mg/visit
Oral
Prednisone - Suggested regimens:
Extensive, active or rapidly spreading alopecia areata in patients ≥60 kg:
40 mg/day PO x 1 week; then
35 mg/day PO x 1 week;
30 mg/day PO x 1 week;
25 mg/day PO x 1 week;
20 mg/day PO x 3 days;
15 mg/day PO x 3 days;
10 mg/day PO x 3 days;
5 mg/day PO x 3 days

Less extensive, active alopecia areata:
20 mg PO 48 hourly
Taper dose slowly by 1 mg/day after condition is stable 		Adverse Reactions
  • Gastritis. If administered long-term: Weight gain, hypertension, cataracts, adrenocortical insufficiency, osteoporosis, muscle wasting, pain or weakness, increased susceptibility to infection, impaired wound healing, electrolyte imbalances
Special Instructions
  • Take with food
  • May be combined with intralesional corticosteroids or Minoxidil solution
Topical
Betamethasone
dipropionate		 0.05% cream, ointment, lotion,
gel		 Apply sparingly to the affected area and 1 cm
beyond 24 hourly 		Adverse Reactions
  • Local effects (burning, stinging, itching)
Special Instructions
  • Discontinue use if skin irritation or contact dermatitis occurs
  • Prolonged administration may result in HPA-axis suppression or manifestations of Cushing’s syndrome
Clobetasol propionate 0.05% cream,
ointment		 Apply sparingly to the affected area 12 hourly Adverse Reactions
  • Metabolic effect (HPA-axis suppression); Dermatologic effects (skin atrophy, telangiectasia, folliculitis, skin hypopigmentation, transient erythema); Local effects (pruritus, burning sensations, skin irritation)
Special Instructions
  • Avoid long-term continuous therapy particularly in infants and children
  • Should be used with caution in patients with DM
  • Occlusive dressings may induce bacterial infections
  • Discontinue if hypersensitivity occurs
*Please see the latest MIMS for specific formulations and prescribing information.

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

Drug Dosage Remarks
Baricitinib 4 mg PO 24 hourly
May be tapered to 2 mg PO 24 hourly if sustained control of disease activity
is achieved 		Adverse Reactions
  • Respiratory effects (upper respiratory tract infection, pulmonary embolism); GI effects (nausea, abdominal pain); Other effects (weight gain, headache, rash, elevated liver enzymes, acne, hypercholesterolemia)
Special Instructions
  • Use with caution in patients with chronic, active, or recurrent infections, abnormal blood cell levels, lipids and liver enzymes, high risk of thromboembolic events
  • Screen for pulmonary TB and treat if positive prior to initiation of therapy
  • Vaccination with live-virus vaccines and use with biological DMARDs, biological immunomodulators, other Janus kinase inhibitors, Ciclosporin or other potent immunosuppressants are not recommended

Other Dermatologicals (Oral)

Drug Dosage Remarks
Finasteride 1 mg PO 24 hourly Adverse Reactions
  • Decreased libido, impotence, ejaculation disorders, hypersensitivity, testicular pain, breast tenderness and enlargement
Special Instructions
  • Daily use ≥3 months is needed before hair growth or prevention of hair loss can be observed
  • Continued use is needed to achieve maximum benefit
    • Discontinuing treatment leads to reversal of effect within 12 months
  • Baseline prostate-specific antigen (PSA) level should be obtained
    • Finasteride lowers PSA level
  • Not recommended for use in females
Ritlecitinib 50 mg PO 24 hourly Adverse Reactions
  • CNS effects (headache, dizziness); GI effects (diarrhea, stomatitis); Dermatologic effects (rash, urticaria, folliculitis, atopic dermatitis); Other effects (fever, increased blood creatine phosphokinase, herpes zoster, decreased red blood cell count)
Special Instructions
  • Use with caution in patients with active TB, hepatitis B or C, absolute lymphocyte count (ALC) <500/mm3 or platelet count <100,000/mm3
  • Perform viral hepatitis screening, ALC and platelet counts prior to therapy initiation and during treatment
  • Use of live attenuated vaccines should be avoided during or shortly prior to initiating treatment

Other Dermatologicals (Topical)

Drug Available
Strength		 Dosage Remarks
Diphenylcyclopropenone
(DPCP, Diphencyprone) 		0.00001-2%

Solution is applied weekly preferably in physician’s office
Sensitization dose: 2% solution applied to 4x4 cm area on one side of scalp. Wash off after 48 hours

  • If after 1 week no reaction or only mild-moderate reaction may continue

Initial dose first week: 0.00001% solution applied to same side of scalp in 2 coats. Wash off after 48 hours

  • Desired response: Mild itching, erythema and scaling

If marked vesicular edematous reaction occurs, do not apply for 1 week

Each week DPCP is applied to same side of scalp and washed off after 48 hours DPCP concentration is adjusted according to response of previous week’s treatment

Once hair growth occurs on one side, the other side of scalp is treated

Adverse Reactions
  • Lymphadenopathy (neck and behind ears), flu-like symptoms, fever, allergic contact dermatitis, blistering, autoeczematization, pigment changes (“dyschromia in confetti”)
Special Instructions
  • Person applying needs to wear gloves
  • Patient must protect treated area from sunlight ≥6 hours (better if 48 hours) after application
    • DPCP is degraded when exposed to light
  • Cover scalp when in close contact with partner (eczema and vitiligo have occurred in spouses of treated individuals)
Minoxidil 2% solution, spray
3% lotion, solution
5% lotion, solution
5% foam 		Solution: 1 mL (6 sprays) applied 12 hourly
Application should begin at the center of the affected area, leave for at least 4 hours
Max dose: 2 mL/day
Foam: 0.5 capful applied 12 hourly in males and 24 hourly in females
Max dose: 1 capful/day

Adverse Reactions

  • Contact dermatitis, pruritus, flushing, local burning, unwanted hypertrichosis especially in women
Special Instructions
  • 1 mL dose should be used regardless of size of affected area
  • Sprays, extended sprays and rub-on applicators are available

Other Eye Preparations

Drug Available
Strength		 Dosage Remarks
Bimatoprost 0.03% ophthalmic
soltion		 Apply 1 drop 24 hourly at night Adverse Reactions
  • Local effects (pruritus, conjunctival hyperemia, ocular irritation, dry eye syndrome, erythema, blepharitis, enophthalmos, discharge, pain, swelling, eyelid edema, iris hyperpigmentation, increased lacrimation, blurred vision)
  • Other effects (headache, skin discoloration)
Special Instructions
  • Place 1 drop on a disposable sterile applicator then apply evenly along the skin of the upper eyelid margin at the base of the eyelashes at night

Topical Antracen Derivative Agent

Drug Available
Strength		 Dosage Remarks
Dithranol (Anthralin) 0.5% ointment
1% ointment		 Short-contact therapy:
Apply to affected area of the scalp 24 hourly
Leave on for 20-30 minutes daily x 2 weeks, then 45 minutes 24 hourly x 2 weeks up to max of 1 hour daily 		Adverse Reactions
  • Burning sensation, skin irritation especially on non-affected skin
  • Staining of skin and hair, which usually clears 2-3 weeks after treatment is discontinued. Staining can also occur on clothes and household items
Special Instructions
  • Remove from scalp with mineral oil and then wash off with soap and water
  • Some patients may tolerate overnight application

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

Related MIMS Drugs