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 recommended by the British Association of Dermatologists' guidelines for the management of alopecia areata 2012 1. The diagnosis of alopecia areata is typically made based on clinical presentation, with characteristic patches of hair loss on the scalp or other hair-bearing areas.
Treatment Options
- For small patches of hair loss, intralesional corticosteroids, such as triamcinolone acetonide 5-10 mg/ml, injected into the affected areas every 4-6 weeks, can be effective, as reported in the British Association of Dermatologists' guidelines for the management of alopecia areata 2012 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 often follows an unpredictable course with spontaneous remissions and recurrences, and emotional support is important as hair loss can significantly impact psychological well-being.
- The condition results from T-cell mediated attack on hair follicles, causing them to enter a dormant phase, and maintenance therapy may be needed to prevent recurrence.
- Contact immunotherapy is the best-documented treatment in severe alopecia areata, but it is not widely available and involves multiple visits to hospital over several months, as reported in the guidelines for the management of alopecia areata 1.
Side Effects and Risks
- Folliculitis is a common side-effect of treatment with potent topical steroids, and patients should be monitored for this and other potential side effects.
- Systemic treatments, such as oral corticosteroids, can have serious side effects, and patients should be carefully selected and monitored for these treatments.
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 can be used for uniform delivery of topical agents to relatively larger areas and may prove to be more efficacious than traditional ILCS 5
- Bimatoprost is a relatively newer treatment modality in AA 3
- Treatment depends on the extent, location, and severity of the condition 3
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
- Bimatoprost has an advantage of lesser side effects, more rapid response, and growth of more pigmented hairs compared to clobetasol propionate 3
- Hair regrowth rate and reduction in SALT score from baseline were seen more in clobetasol group compared to bimatoprost, but the difference was not significant 3
- Side effects were seen more in the clobetasol group compared to bimatoprost group 3
Adverse Effects of Treatment
- High potency topical corticosteroids can lead to several adverse effects, including tinea versicolor of the neck 6
- Prolonged application of high potency topical steroids on the scalp can cause rare but possible side effects, such as tinea versicolor of the neck 6
- A small proportion of patients experienced adverse effects with TC, IC, and CC treatment regimens 4