How to Talk to Your Dermatologist About Treatment-Resistant Alopecia Areata

Sometimes alopecia areata doesn’t respond to first-line approaches. When you’ve tried a number of these therapies without noticeable hair regrowth, you might be said to have “treatment-resistant” alopecia areata, says Alexandra Bowles, DO, a board-certified dermatologist at MONA Dermatology in Cincinnati.

“When those treatments don’t work, it doesn’t mean there’s no hope,” she says. “It just means the condition is a bit more stubborn and may require a different approach.”

It may feel discouraging to have to try yet another treatment, but it’s worth making the most of your next dermatology appointment to figure out your best plan of action.

“Treatment-resistant alopecia areata can be incredibly frustrating. But dermatology is advancing quickly in this area, and if something didn’t work in the past that doesn’t mean there isn’t something that will help in the future,” Dr. Bowles says. “Every case of alopecia areata is unique, so it's important to look at the whole picture to create a plan that gives each patient the best possible chance for regrowth and confidence again.”

Here are a few important things to remember before your next doctor's visit so you can be on that path, too.

If you’re seeing a doctor you’ve seen before, your medical records should tell them the treatments you’ve tried in the past. Still, it may be helpful to prepare and bring your own list. Include all the treatments and medications you’ve tried, how long you used them, and the response you noticed, Bowles says. “It gives your dermatologist a clear picture of your treatment history and helps avoid repeating things that didn’t work or caused side effects,” she says.

It’s also helpful to talk about any frustrations you experienced with each treatment. For example, if it was so annoying to use a specific medication that you gave up after a month, when it really needs more time to work, your dermatologist should know that.

“That conversation can help identify how we can get you better or how we can help you make it most useful for your time,” says Arash Mostaghimi, MD, MPH, an associate professor of dermatology at Harvard Medical School and the vice chair of clinical trials and innovation in dermatology at Brigham and Women’s Hospital in Boston.

Sometimes alopecia areata responds to treatment initially and then a certain therapy stops working as well, says Rehan Karim, DO, a board-certified dermatologist with U.S. Dermatology Partners in North Dallas, Texas.

Dr. Karim also recommends sharing other recent changes in your life or medical history, such as new stressors, a recent pregnancy, or a diagnosis of another autoimmune disease that could either be contributing to hair loss or change the type of treatment options he might suggest trying next.

Make sure you and your dermatologist are on the same page by letting them know what matters most to you.

“You might say something like, ‘My biggest concern is the patch on my scalp that’s getting larger,’ or ‘I’m really struggling with how unpredictable the shedding has been,’” Bowles says. “Being specific helps us prioritize what to focus on during the visit, whether that’s regrowth, scalp comfort, or emotional support. The more we understand your experience, your goals, and how this condition impacts your life, the better we can tailor a plan that feels right for you.”

This also helps your dermatologist offer up solutions that are more likely to fit your preferences and lifestyle. For example, if you only wash your hair once a week, a shampoo to use every day isn’t your best bet, but if your dermatologist doesn’t know that, they can’t be as helpful, Dr. Mostaghimi says.

Your main concern might also be more of an emotional one. “Sharing how alopecia areata affects your confidence, social life, or daily activities gives your dermatologist a better sense of the whole picture,” Bowles says. “It is never just about your hair. It’s about how the condition affects your quality of life.”

Dermatologists are familiar with the emotional toll alopecia areata can take. Mostaghimi says he often finds himself offering reassuring words, such as, “It’s okay to be sad about this; you've gone through something traumatic.” But if your doctor doesn’t bring up the emotional side of alopecia areata, try saying something like: “Can we spend a moment talking about how this is impacting me?” he suggests.

When you make time for this part of the conversation, your dermatologist might also be able to offer resources you may not have known about or considered before, such as support groups or therapy, he adds.

Plus, when your dermatologist is fully aware of how you’re coping, they may be better equipped to advocate on your behalf. “This information can also be helpful for insurance documentation if we need to justify coverage for advanced therapies,” Bowles says.

Your dermatologist knows you’ve probably been searching online for answers. So don’t feel shy about bringing up treatments you’ve heard or read about. “Most patients have already done some research before coming in, and I welcome those questions,” Bowles says. “It opens up a great dialogue about what’s new, what’s evidence-based, and which treatments are the best fit for your particular situation.”

When you are doing your own research, try to stick to reputable sources, such as the National Alopecia Areata Foundation or the American Academy of Dermatology Association. Trends you may have heard about on social media can be a bit misleading, but bringing them up can open up a discussion that ultimately dispels some misconceptions, Karim says.

You can always ask your dermatologist about enrolling in a trial, particularly if you haven’t experienced the results you’re looking for from treatment so far, Bowles says. You can search for relevant clinical trials through the National Alopecia Areata Foundation and ClinicalTrials.gov, Mostaghimi says.

This appointment might be an emotional one, which can make it even trickier to remember all the key points your dermatologist covers. Consider taking notes or bringing a trusted loved one with you to the appointment who can help be your eyes and ears.

“It’s also completely okay to pause and ask for clarification; I want my patients to leave feeling informed and supported, not overwhelmed,” Bowles says.

Before the appointment ends, you can also summarize everything you’ve heard to make sure you’re both in agreement, she adds.

Karim will often offer to type what he’s talking about directly into the Notes app on a patient’s phone so they can refer back to the information anytime, and he also lets them know the best way to contact him. “If they have any kind of concerns come up later on, I'm always here for them,” he says.

You should leave this appointment with a clear understanding of what happens next.

“Before you go, take a moment to review the plan out loud with your dermatologist, something like, ‘So we’re starting this medication and following up in six weeks, right?’” Bowles says. Or, “I’m going to get these lab tests, I’m going to read about two treatment options, and then I’m going to send you a message in a week telling you which one I’d like to try,” Mostaghimi says. These types of recaps only take a few moments and ensure you’re aligned, he says.

You can ask for written instructions or an appointment summary, which is often available through online patient portals, Bowles adds.

“I also recommend noting when to expect follow-up results so you’re not left wondering,” she says. “Clear communication makes the process smoother and helps you feel confident about what comes next in your treatment journey.”

• Alopecia areata is a type of autoimmune hair loss that results in patchy bald spots on the scalp and other body parts. When it doesn’t respond to first-line treatment, it may be considered “treatment-resistant” alopecia areata.
• Before you see a dermatologist to talk about alopecia areata that hasn’t responded to treatments in the way you’d like, prepare a list of what you’ve tried and how it affected you.
• Plan to discuss how you’re feeling about your hair loss, any treatments you’ve learned about and are curious to try, and your main concerns about your hair loss, so you and your dermatologist can set priorities.
• Consider taking notes during the appointment, bringing a trusted loved one with you for support, and recapping what you heard before you leave, to ensure you didn’t miss key points and you know what to do next.