From the Guidelines
Alopecia areata treatment should prioritize intralesional corticosteroid injections, such as triamcinolone acetonide 5-10 mg/ml, administered every 4-6 weeks, as they are highly effective for limited patches, with a response rate of 62% in patients with fewer than five patches of < 3 cm in diameter, as reported in the British Association of Dermatologists' guidelines for the management of alopecia areata 2012 1.
Treatment Options
- Intralesional corticosteroids: Depot corticosteroid injected intralesionally stimulates hair regrowth at the site of injection in some patients, with the effect lasting about 9 months 1.
- Topical corticosteroids: Very potent topical steroids, such as clobetasol 0.05% applied twice daily for 3-6 months, are first-line treatments for mild to moderate cases, reducing inflammation around hair follicles 1.
- Minoxidil: Topical 1% or 3% minoxidil solution applied twice daily can stimulate regrowth, but the response rate is limited, with 33% and 32% of patients experiencing regrowth in controlled trials 1.
Considerations
- Patient counselling is essential, including discussion of the nature and course of the disease, available treatments, and potential psychological support 1.
- Treatment selection depends on disease extent, patient age, and comorbidities, with most patients requiring 3-6 months of consistent treatment before significant regrowth occurs.
- Systemic treatments, such as oral corticosteroids, JAK inhibitors, and immunosuppressants, may be considered for extensive or resistant cases, but their use should be carefully weighed against potential side effects and benefits.
From the Research
Treatment Options for Alopecia Areata
- The treatment of alopecia areata is challenging due to its unpredictable course and the lack of a curative treatment 2.
- Various treatments have been introduced, including topical and intralesional corticosteroids, which are thought to reduce the CD8+ T-cell-mediated immune attack on hair follicles 3.
- Topical corticosteroids are safe and well tolerated with moderate efficacy in mild alopecia areata, but recurrence is common after treatment cessation 3.
- Intralesional corticosteroids are more effective than topical steroids and have higher success rates in mild-to-moderate alopecia areata 3.
- Other treatment options include:
- Immunotherapy with diphenylcyclopropenone (DCP), which has an overall response rate of 70.6% and complete remission in 30.9% of patients 4.
- Minoxidil, which has had limited success in stimulating hair regrowth without altering the course of alopecia areata 5.
- Short-contact anthralin therapy, which has shown promise, especially in children 5.
- Contact sensitizers, phototherapy, and immunomodulators such as inosiplex, cyclosporine, and nitrogen mustard 5.
- Biologics, such as baricitinib, which has been shown to increase short-term and long-term hair regrowth compared to placebo 6.
Factors Influencing Treatment Choice
- The extent of hair loss is a significant factor in determining the treatment modality for alopecia areata 2.
- Disease activity and the likelihood of progression also play a crucial role in choosing the treatment approach 2.
- Combination therapy with adjuvant modalities may be more desirable if the disease activity is high and likely to progress 2.
Efficacy and Safety of Treatments
- The efficacy of treatments for alopecia areata varies widely, and the long-term efficacy of current treatments is minimal 2.
- The evidence for the effectiveness of various treatments is often uncertain, and further research is needed to establish the ideal treatment regimens and long-term safety 3, 6.
- Serious adverse events are a concern with some treatments, and the risk of bias in studies is often high due to limitations in study design and reporting 6.