In cases of severe hair loss, limited success has been achieved by using the corticosteroids clobetasol or fluocinonide , corticosteroid injections, or cream. The cream is not as effective and it takes longer in order to see results. Steroid injections are commonly used in sites where the areas of hair loss on the head are small or especially where eyebrow hair has been lost. Whether they are effective is uncertain. Some other medications that have been used are minoxidil , Elocon (mometasone) ointment (steroid cream), irritants (anthralin or topical coal tar), and topical immunotherapy ciclosporin , sometimes in different combinations. Topical corticosteroids frequently fail to enter the skin deeply enough to affect the hair bulbs, which are the treatment target,  and small lesions typically also regrow spontaneously. Oral corticosteroids decrease the hair loss, but only for the period during which they are taken, and these drugs can cause serious side effects . 
To prevent treatment-induced postinflammatory hyperpigmentation, therapies that cause irritation or inflammation should be avoided. When prescribing a retinoid, physicians should start at lower concentrations and titrate up as tolerated. It is best to begin with infrequent dosing (., twice weekly to every other day), and to choose more tolerable formulations, such as creams over gels. Examples of topical retinoids include adapalene % (Differin), tretinoin (Retin-A), and tazarotene (Tazorac). 37 , 49 Benzoyl peroxide can be drying and irritating; using lower concentrations (less than 5%) can limit irritation and subsequent postinflammatory hyperpigmentation. For patients presenting with acne and postinflammatory hyperpigmentation, azelaic acid 20% cream (Azelex), azelaic acid 15% gel (Finacea), topical retinoids, and chemical peels may be helpful in doses that do not cause irritation or inflammation. 37 , 38 , 42 – 45 , 50 If treatment with topical agents is unsuccessful, physicians may consider prescribing systemic antibiotics, hormonal therapies such as spironolactone (Aldactone) or oral contraceptives, or isotretinoin for recalcitrant cases.