From the Guidelines
Alopecia areata treatment should prioritize topical corticosteroids like clobetasol 0.05% applied twice daily for 4-6 weeks as the first-line treatment for mild cases with small patches, as evidenced by the British Association of Dermatologists' guidelines 1.
Treatment Options
The treatment of alopecia areata depends on the severity and extent of hair loss. For limited patches,
- Topical corticosteroids are a viable option, with clobetasol 0.05% being a commonly used treatment 1.
- Intralesional corticosteroid injections, such as triamcinolone acetonide 5-10 mg/ml, can be highly effective for limited patches and are administered every 4-6 weeks directly into affected areas 1.
Extensive Hair Loss
For more extensive hair loss,
- Systemic treatments may be necessary, including oral corticosteroids, JAK inhibitors like tofacitinib or baricitinib, or immunosuppressants such as methotrexate.
- Minoxidil 5% solution applied twice daily can help stimulate regrowth when used alongside other treatments.
Condition Overview
Alopecia areata is an autoimmune condition that causes hair loss in patches, typically on the scalp but sometimes affecting other areas of the body. The condition results from immune cells attacking hair follicles, causing inflammation that disrupts normal hair growth. While alopecia areata isn't permanently damaging to follicles, the unpredictable nature of the condition means some patients experience spontaneous regrowth while others have persistent or spreading patches.
Psychological Support
Psychological support is important as hair loss can significantly impact emotional wellbeing.
Side Effects and Considerations
Folliculitis is a common side-effect of treatment with potent topical steroids 1. Intralesional corticosteroids may also cause patient discomfort, and the main limitation of this treatment is the number of injections that can be given 1.
From the Research
Overview of Alopecia Areata
- Alopecia areata is an autoimmune condition characterized by non-scarring hair loss, affecting 2% of the population worldwide 2.
- The condition can range from patchy hair loss to total loss of scalp and body hair, with severity varying widely among individuals 3.
Treatment Options
- Contact immunotherapy with diphenylcyclopropenone or squaric acid dibutyl ester is a preferred treatment for severe alopecia areata, with an overall hair regrowth rate of 65.5% 4.
- Topical and intralesional corticosteroids are commonly used treatments, with moderate efficacy in mild cases, but recurrence is common after treatment cessation 2.
- Minoxidil has been shown to be effective in treating patchy alopecia areata, with a significant difference in favor of 5% minoxidil compared to placebo 3.
- Other treatment options include systemic steroids, topical immunotherapy, and biologics targeting immune response, as well as innovative therapies such as lasers and autologous platelet-rich plasma therapy 5.
Factors Affecting Treatment Outcomes
- Disease extent, atopic history, and nail involvement have been associated with poorer therapeutic outcomes in patients with alopecia areata 4.
- Recurrence rates are higher in patients not receiving maintenance treatment, highlighting the importance of ongoing therapy 4.
- The quality of evidence for many treatments is moderate, and further research is needed to fully elucidate the role of different therapies in clinical practice 6, 3.
Efficacy and Safety of Treatments
- The majority of published randomized controlled studies on alopecia areata are of moderate quality, with many treatments showing efficacy but also having limitations and potential side effects 6.
- Minoxidil has been shown to be safe and effective in treating patchy alopecia areata, with no severe adverse events reported 3.
- Further studies are needed to address remaining uncertainties and to fully establish the efficacy and safety of different treatments for alopecia areata 3, 5.