If you are wondering how effective steroid injections for hair loss are in treating alopecia areata, you are likely one of the 2% of the worldwide population who is experiencing this condition [1]. The good news is that intralesional steroid injections were found to improve symptoms in over 60-80% of cases of mild and moderate alopecia areata [2][3]. However, they are less efficient in treating its severe forms, such as alopecia totalis.
While steroid injections are primarily used to treat alopecia areata, they can also help reduce inflammation and improve the symptoms of other autoimmune scalp conditions, such as frontal fibrosing alopecia or discoid lupus. Furthermore, they are sometimes prescribed to treat common scalp problems, such as lichen planopilaris or scalp psoriasis [4].
Of course, like most medications, steroid injections can also have unwanted side effects. Depending on the type of medication used, you may be experiencing symptoms such as pain and bruising, infection, scalp folliculitis or scalp atrophy [5][6]. People who are sensitive to corticosteroids or have other health conditions may suffer even more severe reactions. However, your trichologist will help you weigh the benefits of this treatment against its risks.
Keep reading this article to find out all you need to know about:
The most common type of steroid injections used to treat scalp conditions which cause hair shedding is called intralesional corticosteroid injections (although the intramuscular variety can sometimes be prescribed [7]). These are steroid medications which are injected directly into the affected regions on your scalp.
Corticosteroids (which should not be confused with the anabolic steroids that make your muscles grow) are a type of anti-inflammatory medication which can improve the symptoms of autoimmune conditions and other types of localised hair loss caused by scalp inflammation.
When you are experiencing an autoimmune disorder that causes hair loss, your white blood cells are attacking your hair follicles. This is achieved through an inflammatory response generated by your immune system.
Normally, this kind of response involves several types of cells working together to destroy microorganisms which can make you sick, such as viruses or bacteria [8]. However, in autoimmune conditions, your immune system “mistakes” your hair follicles (and sometimes, other kinds of cells in your body) for harmful microorganisms and targets them instead. When your hair follicles are damaged by inflammation, they can no longer produce hair.
Steroid injections play a role in regulating your immune system and reducing inflammation [5]. Thus, they prevent your white blood cells from attacking your hair follicles and also help relieve inflammation symptoms, such as redness, swelling, itchiness, pain or a burning sensation on your scalp.
The effectiveness of steroid injections for hair loss depends on several factors:
While steroid injections can be very effective in treating alopecia areata and other auto-immune and/or inflammatory scalp conditions, they do not have any effect against different, non-inflammatory types of alopecia, such as androgenetic alopecia or telogen effluvium.
Here are the main hair loss-inducing conditions that steroid injections are most often prescribed for and the medications’ efficiency in treating them:
Alopecia areata
Symptoms:
Intralesional corticosteroid injections have been found quite effective in treating alopecia areata, especially in mild or moderate forms.
Depending on the type of steroid used, one study found hair regrowth in 97%, respectively 64% of the two groups who received different steroid injections [9].
Another study performed on 290 patients with alopecia areata revealed that 61% of them went into remission after receiving 1-2 intralesional steroid injections [10].
A different clinical trial revealed that 82% of its 127 patients with limited alopecia areata experienced an over 50% improvement in hair growth after steroid injections.
Furthermore, patients with moderate to severe forms of this condition also saw 25%-50% hair growth after 6 months of intralesional corticosteroid injections [2]. These findings are confirmed by another, similar study on 120 patients with the same condition, where intralesional corticosteroid injections had an 83.3% efficiency rate [10].
However, be aware that while steroid injections can stop alopecia areata from spreading and even regrow hair, this does not imply the condition is permanently cured. While in 30-50% of cases, it is known to go into remission within 12 months even without treatment, it can often have several relapses over the years [11][7].
Lichen planopilaris
Several literature reviews have found intralesional corticosteroid injections efficient in treating lichen planopilaris lesions, as they can reduce inflammations substantially[12][13].
One study showed that injections with systemic corticosteroids led to full remission in 83% of 73 patients with generalised lichen planopilaris [14].
However, some authors caution that this treatment is more invasive than other options, such as oral medication (which can be as effective [14]). That is because it can cause scalp denting or atrophy [12].
Frontal fibrosing alopecia
Intralesional corticosteroids are the first line of treatment for frontal fibrosing alopecia.
One study performed on 130 patients who experienced this condition revealed that 83% of them showed a positive clinical response to intralesional corticosteroids. 34% of the total number of patients achieved improvement, 49% achieved stabilisation and 5% continued disease progression (data was unavailable for the remaining 16%) [15].
The efficacy of steroid injections in the treatment of frontal fibrosing alopecia was also confirmed by other, smaller studies [16].
Discoid lupus
When the first line of treatment for discoid lupus skin and scalp lesions – topical steroids (such as steroid creams) – fails, intralesional steroid injections can prove efficient in some cases.
A study performed on 28 patients with face and head lesions caused by discoid lupus revealed that 46% of the patients experienced full remission of their lesions and another 46% experienced considerable improvements after 1-9 intralesional corticosteroid injections [17].
This confirmed the findings of observational studies which had also noted positive results of steroid injections in treating discoid lupus lesions which resisted topical steroid treatment [18].
However, since few clinical trials have been conducted on this matter, more research is needed to ascertain these results.
Scalp psoriasis
While topical steroids are the first line of treatment for scalp psoriasis, some researchers think that steroid injections can also provide benefits when used together with topical treatments [19].
While this approach has shown promise in treating psoriasis of the limbs [4], no studies have yet been performed to determine the efficacy of corticosteroid injections on scalp psoriasis [19]
There are different types of injectable corticosteroid medications, each with specific uses. Research has found that certain concentrations of steroids called betamethasone dipropionate and triamcinolone acetonide may be the most efficient in treating alopecia areata [20][1].
When it comes to treating alopecia areata, steroid injections are generally effective against mild or moderate hair loss, which affects under 50% of the scalp. However, while more research is needed to confirm this, there is also a study which found that intralesional steroid injections can also reduce symptoms in 6 out of 10 patients with severe alopecia areata (between 50% and 99% hair loss) [21].
Each person has their own biological characteristics (e.g. age, health condition, immune response), and lifestyle choices (e.g. smoking, diet, alcohol intake) which can impact their response to injectable corticosteroids.
Scalp atrophy induced by intralesional corticosteroid injections [1]
While steroid injections are generally considered safe [10], some patients may experience the following unwanted side effects (this list can vary with the type and concentration of the injected steroids) [1][5]:
No, steroids do not cause hair loss when they are injected into your scalp to treat alopecia. The link between balding and steroids usually stems from the fact that the anabolic kind (the ones certain athletes take to increase their muscle mass more rapidly) can indeed trigger male-pattern baldness or female-pattern baldness. But corticosteroids are different substances, which do not have the same effect.
While there are certain steroids (e.g. Prednisolone) which have hair thinning listed among their unwanted side effects [22], these are not used for intralesional injections. The medication types, concentrations and doses used for treating scalp conditions are generally considered safe and are not known to make your hair fall out.
Topical and oral steroids can also help reduce inflammation and improve the symptoms of certain kinds of alopecia. However, the main benefits of intralesional steroid injections are that they ensure better penetration than topical ones, while at the same time, being more targeted than oral ones. This helps them reach the affected area faster and reduces side effects to the rest of your body.
While intralesional steroid injections are the first line of treatment for alopecia areata [2], topical steroids are usually prescribed first in treating scalp problems such as psoriasis or dermatoses, as they are less invasive, while injections are offered after topical treatments have failed.
Since steroid injections break the skin, the risk of certain local side effects, such as pain, bruising, infection, or thinning of the scalp (scalp atrophy) is also higher.
The amount of time before you start seeing results from your steroid injection treatment can vary with the condition you are treating, the type of corticosteroids you are using and your body’s response to the medication.
Since treatment sessions are usually spaced 4-6 weeks apart, it can take a few weeks of steroid injections before you can expect to see improvement in your hair loss. One study conducted on alopecia areata patients reported that it took 2-4 weeks to see the emergence of new hair after intralesional injections with each of 2 different steroids [9], but that can vary. Alopecia UK states that it generally takes 4-6 weeks before you can start seeing results [23].
However, if you have seen no improvement after 6 months of steroid injection treatment, the medication is likely not working for you [2].
While prices may vary, a session of steroid injections for hair loss usually costs between £100 and £500 in the UK. The treatment for alopecia areata includes, on average, 3-4 sessions, so you can expect to pay somewhere between £300 and £2000 for a full course of steroid injections.
Your GP may prescribe steroid injections for certain conditions, such as sciatica, or arthritis. However, it is unlikely that you can get alopecia areata treatment on the NHS. When used to improve the symptoms of conditions that cause hair loss, steroid injections are registered as having cosmetic purposes, and their cost is generally not supported by the NHS. Fortunately, you can still get them in private hair clinics.
If you are experiencing hair loss that does not improve with home care or over-the-counter treatments, it is time to book a consultation with an experienced trichologist. They will perform specific tests to determine the cause of your hair shedding, such as a dermoscopy, a scalp biopsy or blood tests for hair loss.
Once you have a confirmed diagnosis, they will recommend the best and safest course of action for your specific condition. Whether that may involve topical, injectable or oral steroids or other effective, evidence-based forms of treatment, you can rest assured that your hair and scalp will be in the most competent hands.
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