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Dermatology · London

Alopecia areata treatment - private in London.

Intralesional steroid, topical minoxidil, and the newer NICE-approved JAK inhibitors baricitinib (Olumiant) and ritlecitinib (Litfulo) - prescribed by a consultant dermatologist with a real alopecia caseload.

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What alopecia areata is

An autoimmune attack on hair follicles - patchy, total, or universal.

Alopecia areata (AA) is a T-cell mediated autoimmune condition in which the immune system attacks anagen hair follicles. It can start at any age and often runs with atopy or other autoimmune conditions such as thyroid disease and vitiligo.

Patchy AA

Round or oval smooth bald patches, usually on the scalp - the commonest presentation.

Alopecia totalis

Loss of all scalp hair. More stubborn to treat, and less likely to remit on its own.

Alopecia universalis

Loss of all scalp and body hair including eyebrows and eyelashes. The severe end of the spectrum.

Assessment

A proper dermatology work-up, not a five-minute check.

Diagnosis is largely clinical, but treatment decisions rest on severity scoring and a small set of bloods.

  • Dermatologist examination

    Distribution, activity signs, ophiasis pattern, nail changes and any co-existing autoimmune features.

  • SALT scoring

    Severity of Alopecia Tool - the percentage of scalp hair loss, used to grade disease and NICE eligibility.

  • Dermatoscopy

    Exclamation-mark hairs, yellow dots and black dots - the hallmarks of active AA under magnification.

  • Pull test

    A simple bedside test for active shedding at the margin of a patch.

  • Thyroid function bloods

    TFTs at baseline given the association with autoimmune thyroid disease.

  • ANA if extensive

    Antinuclear antibodies where the picture suggests wider autoimmunity.

Indicative pricing

What private alopecia areata treatment costs in London.

Indicative ranges across our London network. Baricitinib and ritlecitinib are also available on the NHS through specialist centres where NICE criteria are met - waiting times vary.

Item Indicative range
Consultant dermatology assessment (SALT scoring, dermatoscopy) £250–£450
Baseline bloods (FBC, TFT, ANA if extensive) £120–£220
Intralesional triamcinolone (per session) £180–£320
Topical minoxidil 5% (private prescription) £25–£45 / month
Baricitinib (Olumiant) private, per month + monitoring £950–£1,400
Ritlecitinib (Litfulo) private, per month £1,000–£1,500
Monitoring bloods (monthly on JAK) £45–£80

Who this is for

The right treatment for your pattern and severity.

Limited patchy disease usually starts with intralesional steroid. Severe or rapidly progressive disease with SALT above 50 is where JAK inhibitors earn their place.

  • Limited patchy alopecia areata

    One to a few round, smooth bald patches - the classic presentation. Often responds to intralesional steroid over 2 to 3 sessions.

  • Extensive or rapidly progressive AA

    SALT above 50 percent, ophiasis pattern, or a sudden run of new patches - a signal to consider systemic treatment early.

  • Alopecia totalis and universalis

    Total scalp or whole-body hair loss. The group most likely to benefit from JAK inhibitors, and least likely to remit spontaneously.

  • Paediatric AA (age 12+)

    Ritlecitinib is licensed from age 12. Psychological impact is often the driving concern - and treated seriously.

  • Nail involvement or atopic background

    Pitting, ridging or trachyonychia alongside patches - a marker of more active disease.

  • Beard, brow or eyelash alopecia

    Focal beard or brow AA responds well to intralesional steroid. Eyelash loss in universalis is a common JAK indication.

Treatment options

From intralesional steroid to oral JAK inhibitors.

Baricitinib (NICE TA926) and ritlecitinib have changed what is possible for severe AA - the first drugs to achieve meaningful regrowth in totalis and universalis, with proper monitoring.

  • Intralesional triamcinolone

    First-line for limited patchy disease. 2.5 to 10 mg/mL every 4 to 6 weeks - the most effective option for small, stable patches.

  • Topical clobetasol 0.05%

    Potent topical steroid under occlusion overnight. Useful in children or patients who decline injections.

  • Topical minoxidil 5%

    Twice-daily adjunct - modest on its own, useful alongside steroid or JAK to encourage regrowth.

  • Topical immunotherapy (DPCP/SADBE)

    Weekly diphencyprone or squaric acid contact sensitiser in specialist centres. Reserved for extensive disease when JAK is not appropriate.

  • Methotrexate 15–25 mg weekly

    Low-dose oral immunosuppressant, sometimes with pulsed steroid. A pre-JAK option, still used where JAK is contraindicated.

  • Baricitinib (Olumiant) - JAK1/2

    NICE-approved (TA926) for adults with severe AA and SALT above 50. 40 to 50 percent achieve SALT-20 by week 36.

  • Ritlecitinib (Litfulo) - JAK3/TEC

    NICE-approved from age 12 for severe AA. The first oral option licensed for adolescents.

  • Short pulse oral corticosteroid

    Occasionally used to halt rapid progression. Not a long-term strategy - relapse on withdrawal is the rule.

Assessment for JAK inhibitors

The workup before baricitinib or ritlecitinib.

NICE requires SALT above 50 for severe AA. Before starting we screen for infection, vaccinate where needed, and confirm cardiovascular and clot risk are acceptable.

  • Severity check

    Confirmed SALT above 50 for NICE eligibility, or well-documented severe disease for private use.

  • Screening bloods

    FBC, LFT, lipid profile and creatinine at baseline, then monthly for six months and quarterly thereafter.

  • TB and hepatitis screening

    Quantiferon or T-spot for latent TB, plus hepatitis B and C serology.

  • Vaccination review

    Live vaccines (MMR, VZV, yellow fever) given before starting where indicated; zoster considered.

  • VTE risk assessment

    Personal or family history of clot, oestrogen use, immobility - factored into the decision to prescribe.

  • MACE risk factors

    Smoking, hypertension, diabetes and cardiovascular history reviewed against the JAK class warnings.

Safety and monitoring

What to expect - honestly.

Steroid injections are low-risk with careful dosing. JAK inhibitors are usually well-tolerated but need a proper monitoring plan and honest counselling on the class warnings.

  • Intralesional steroid: skin atrophy

    Small dimples or telangiectasia at injection sites are the main risk - usually settle over months with careful dosing.

  • JAK: infection risk

    Increased upper respiratory and herpes zoster infections. TB and hepatitis screening before starting, zoster vaccination considered.

  • JAK: blood monitoring

    Monthly FBC, LFT and lipids for the first six months, then quarterly. Cytopenias and lipid changes are usually manageable.

  • JAK: VTE and MACE signal

    A class warning from rheumatology data. We review cardiovascular risk factors, smoking and clot history before prescribing.

  • Live vaccine timing

    Live vaccines are avoided while on JAK - MMR, VZV and yellow fever ideally given before starting.

  • Pregnancy

    JAK inhibitors are not recommended in pregnancy. Effective contraception is required for women of childbearing age.

  • Relapse after stopping

    Hair often falls again within months of stopping a JAK. Long-term use is common, and reviewed annually with the consultant.

  • Psychological wellbeing

    AA has a large emotional impact, especially in children and young adults. Alopecia UK support and CBT for adjustment are offered alongside.

Where in London

A small panel of London dermatology units for alopecia areata.

Consultant-led clinics with a real alopecia caseload and, where needed, paediatric input and a JAK monitoring pathway.

  • Cadogan Clinic, Chelsea

    Consultant dermatology with intralesional steroid and biologics support.

  • Cranley Clinic

    Central London hair and scalp specialists with alopecia expertise.

  • London Dermatology Centre

    Consultant-led private dermatology with a JAK monitoring pathway.

  • HCA The Wellington Dermatology

    St John's Wood - large private dermatology unit with pharmacy support.

  • King's Private Dermatology

    NHS-linked private dermatology at King's College Hospital.

  • Chelsea and Westminster Private Dermatology

    NHS-linked private service with established biologics and JAK pathways.

  • GOSH International Private paediatric

    Private paediatric dermatology at Great Ormond Street for children with severe AA.

Psychological support

Hair loss is not just cosmetic.

The impact on wellbeing is significant, especially in children, teenagers and young adults. We link patients into Alopecia UK for peer support and, where needed, refer for CBT for adjustment. Wig services are available on the NHS and privately.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Frequently asked

Everything we get asked about alopecia areata.

  • Will my hair grow back permanently?

    Alopecia areata is unpredictable. Around 50 percent of patients with limited patchy disease regrow within a year without treatment, but relapse is common. Treatment aims to speed regrowth and hold it - not to guarantee a permanent cure. Severe disease (totalis, universalis) is less likely to remit on its own, and JAK inhibitors work while you take them but hair often falls again on stopping.

  • Are JAK inhibitors safe?

    Baricitinib and ritlecitinib have been through NICE appraisal and are well-tolerated in most patients. The main considerations are infection risk (particularly herpes zoster), lipid changes, and a class warning about clots and cardiovascular events based on rheumatology data. We screen for TB, hepatitis and cardiovascular risk before starting and monitor bloods monthly, then quarterly.

  • Does private insurance cover alopecia areata treatment?

    Cover varies. Most insurers fund the initial dermatology assessment and intralesional steroid sessions. JAK inhibitors are usually funded only when NICE criteria are met (severe AA, SALT above 50) and often need pre-authorisation. We check your policy before booking.

  • Can children have treatment for alopecia areata?

    Yes. Ritlecitinib (Litfulo) is NICE-approved from age 12 for severe AA. Younger children are managed with topical steroid, occasionally intralesional steroid if they tolerate injections, and psychological support. We use specialist paediatric dermatology clinics for children under 16.

  • What if I have alopecia universalis?

    Alopecia universalis - loss of scalp, brow, lash and body hair - is the group most likely to benefit from JAK inhibitors, because spontaneous regrowth is rare. Response rates are lower than for patchy disease, but meaningful regrowth is achievable in a significant minority. Realistic expectations and psychological support are part of the plan.

  • Can I get a wig on the NHS?

    Yes, NHS patients can access synthetic wigs through hospital dermatology or oncology wig services, sometimes subsidised. Private bespoke wigs and hair systems are separate and usually self-funded. Alopecia UK maintains a directory of vetted suppliers.

Related treatments and conditions

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