What is the diagnosis and treatment plan for a 47-year-old male patient presenting with a bald spot, approximately the size of a quarter, on the left posterior aspect of the head, which developed three months ago during a period of high stress while incarcerated, and is being treated with Clobetasol (clobetasol propionate) 0.05% twice daily for 30 days, with laboratory tests including Complete Metabolic Panel (CMP), Rapid Plasma Reagin (RPR), and C-Reactive Protein (CRP)?

From the Guidelines

The patient's treatment plan with Clobetasol propionate 0.05% applied twice daily for 30 days is a reasonable approach for limited alopecia areata, as supported by the British Association of Dermatologists' guidelines 1. The patient is a 47-year-old male inmate with a quarter-sized bald spot on the left posterior scalp that developed three months ago during a period of stress. This presentation is consistent with alopecia areata, a common autoimmune condition that causes well-defined patches of hair loss. Some key points to consider in the management of this patient include:

• The use of high-potency topical corticosteroids like Clobetasol propionate 0.05% as first-line therapy for limited alopecia areata, as they have shown some effectiveness in promoting hair regrowth 1.
• The potential side effects of treatment with potent topical steroids, such as folliculitis, which should be monitored during the treatment period 1.
• The importance of ruling out other potential causes of hair loss, such as systemic inflammation, syphilis, or metabolic abnormalities, through laboratory tests like CMP, RPR, and CRP.
• The role of stress as a known trigger for alopecia areata, which aligns with the patient's history.
• The need for a follow-up appointment in 30 days to assess treatment response and consider alternative therapies, such as intralesional corticosteroid injections or minoxidil, if no improvement occurs after the initial treatment period. Key considerations for the patient's treatment and follow-up include:
• Monitoring for signs of treatment response, such as hair regrowth, and adjusting the treatment plan as needed.
• Educating the patient on the potential side effects of treatment and the importance of adhering to the prescribed treatment regimen.
• Considering the patient's stress levels and potential triggers for alopecia areata in the development of a comprehensive treatment plan.

From the FDA Drug Label

Clobetasol propionate topical solution should be applied to the affected scalp areas twice daily, once in the morning and once at night. Clobetasol propionate topical solution is potent; therefore, treatment must be limited to 2 consecutive weeks and amounts greater than 50 mL/week should not be used. The patient is prescribed Clobetasol propionate 0.05% BID for 30 days, which exceeds the recommended treatment duration of 2 consecutive weeks.

• The recommended treatment duration is 2 weeks, and the patient is prescribed for 30 days.
• The prescription should be limited to 2 consecutive weeks to minimize potential side effects, such as HPA axis suppression. 2

From the Research

Patient Presentation and Treatment

• The patient presents with a bold spot on the back of the head, which started three months ago, and reports being stressed at the time of its development.
• The patient has been prescribed Clobetasol propionate 0.05% BID for 30 days, and laboratory tests such as CMP, RPR, and CRP have been ordered.
• A follow-up appointment is scheduled in 30 days to reassess the patient's condition.

Efficacy of Clobetasol Propionate

• A study published in 2003 3 found that Clobetasol propionate 0.05% under occlusion was effective in inducing hair regrowth in patients with alopecia areata totalis or universalis.
• Another study from 2021 4 evaluated the effect of Clobetasol propionate 0.05% under occlusion on patients with active phase alopecia areata and found it to be effective, with minimal risk of elevating intraocular pressure.
• A comparison study from 2012 5 found that Clobetasol propionate 0.05% was as effective as topical pimecrolimus 1% in treating alopecia areata, but had more side effects.

Alternative Treatment Options

• Platelet-rich plasma (PRP) has been studied as a potential treatment for alopecia areata, with some studies suggesting it may be effective in stimulating hair growth 6, 7.
• A systematic review and meta-analysis from 2022 7 found that PRP was a promising topical, steroid-free treatment modality for alopecia areata, with no significant difference in efficacy compared to triamcinolone acetonide.