From the Guidelines
Alopecia areata is an autoimmune condition that causes hair loss in patches, typically on the scalp but can affect any hair-bearing area, and the first-line treatment for limited disease is topical corticosteroids, such as 0.05% clobetasol propionate foam, as it has shown to be effective in promoting hair regrowth 1. The diagnosis of alopecia areata is typically made based on clinical presentation, with characteristic patches of hair loss on the scalp or other areas of the body.
Treatment Options
- For small patches of hair loss, intralesional corticosteroids, such as triamcinolone acetonide 5-10 mg/ml, can be effective in stimulating hair regrowth, with studies showing that 62% of patients achieved full regrowth with monthly injections 1.
- Topical minoxidil 5% solution applied twice daily can also stimulate regrowth, although the evidence for its effectiveness is limited.
- For extensive hair loss, systemic treatments may be necessary, including oral corticosteroids, JAK inhibitors, or immunosuppressants, although the evidence for these treatments is not as strong as for topical corticosteroids.
Important Considerations
- Patients should understand that alopecia areata results from immune cells attacking hair follicles, causing inflammation that disrupts normal hair growth.
- The condition can be unpredictable, with spontaneous regrowth occurring in many cases, particularly for those with limited disease.
- However, more extensive or long-standing cases may be more resistant to treatment, and psychological support is important as hair loss can significantly impact emotional well-being.
- Potential side effects of treatment, such as folliculitis from topical corticosteroids, should be considered and monitored 1.
From the Research
Diagnosis of Alopecia Areata
- The diagnosis of alopecia areata is mostly clinical 2
- Severity of alopecia can be measured using the Severity of Alopecia Tool (SALT) score 3
Treatment Options for Alopecia Areata
- Topical corticosteroids (TC) and/or intralesional corticosteroids (IC) are considered first-line treatments for patch-type alopecia areata (AA) 4
- Intralesional corticosteroid (ILCS) is a usual therapeutic choice in limited disease 5
- Microneedling with local application of injectable triamcinolone acetonide (TA) is an effective drug delivery system and can cause release of growth factors 5
- Bimatoprost is a relatively newer treatment modality in AA, with advantages of lesser side effects, more rapid response, and growth of more pigmented hairs 3
- Treatment plan can be designed according to the patient's age and extent of disease, with therapeutic agents organized according to their efficacy and safety profiles into first-line, second-line, and third-line options 2
Efficacy and Safety of Treatment Options
- The response rates of initial and significant hair regrowth were comparable among TC, IC, and combined topical and intralesional corticosteroids (CC) treatment groups 4
- Multivariate analysis revealed that an AA treatment duration of longer than 6 months was associated with a lower probability of significant hair regrowth 4
- Bimatoprost has an advantage of lesser side effects, more rapid response, and growth of more pigmented hairs compared to clobetasol propionate 3
- Side effects such as tinea versicolor of the neck can occur with the use of high potency topical corticosteroids under occlusion 6