Topical steroids

• The most common form of corticosteroids for alopecia areata treatment is a topical cream applied directly to the affected area. Topical corticosteroids come in a wide variety of brand names and strengths, and are often prescribed by a physician.
  
  The 1 percent hydrocortisone formula that can be bought over the counter is often not strong enough affect hair growth. Topical steroids should be of appropriate strength to treat the disease, but not too strong as to create negative side effects, such as hair follicle damage, excessive hair growth and acne.
  
  

Intralesional injections

• Corticosteroids can also be injected below the skin, directly to the affected roots, to stimulate hair growth. These are known as intralesional injections and must be prescribed by a doctor. The injection must be precise; injected too deep or too high, and the steroids will be virtually useless. Once the disease has affected more than half of the scalp, the use of intralesional injections is not recommended due to the sheer amount of the drug needed to cover the scalp.
  
  The most common side effect is skin atrophy caused by excessive amounts of the drug being injected in one spot. If injections continue, this atrophy can become permanent. There have been reports of glaucoma or cataracts and, rarely, blindness linked to injections near the front of the scalp.
  
  

Systemic administration

• Systemic administration (either orally or through direct injection into muscles) places the highest amounts of corticosteroids into the body. Systemic corticosteroid treatment has been proven to be highly effective in regrowing hair, but relapses often occur upon ending the treatment or lowering the dosage. The treatment must be administered by a physician and cannot be simply discontinued. Instead, the body must be weaned off the drug.
  
  Systemic administration is usually a treatment of last resort as it can cause serious side effects, such as high blood pressure, diabetes, immune system suppression, osteoporosis and blood clots in the heart.