From the Guidelines
Alopecia areata is an autoimmune condition causing hair loss in patches, typically on the scalp, and treatment depends on severity, often including topical corticosteroids like clobetasol 0.05% applied twice daily for 4-6 weeks, or intralesional steroid injections (triamcinolone acetonide 5-10mg/ml) administered every 4-6 weeks, as supported by the British Association of Dermatologists' guidelines 1.
Diagnosis and Treatment
The diagnosis of alopecia areata is primarily clinical, based on the characteristic patches of hair loss. Treatment options vary depending on the extent and severity of the condition.
- For limited patchy hair loss, intralesional corticosteroid injections are recommended (B III) 1.
- For extensive patchy hair loss, contact immunotherapy may be considered, although it is not widely available and has a lower response rate in patients with alopecia totalis or universalis 1.
- Topical corticosteroids, such as clobetasol 0.05%, can be used for limited patchy hair loss, but the evidence for their effectiveness is limited 1.
- Minoxidil 5% solution can help stimulate regrowth when applied twice daily, although its effectiveness may vary depending on the individual and the severity of the condition.
Role of Micronutrients
Recent studies have also explored the role of micronutrients, such as vitamin D and zinc, in the treatment of alopecia areata.
- Vitamin D has been shown to play a role in the normal hair follicle, and lower serum vitamin D levels have been associated with alopecia areata 1.
- However, the evidence for the use of vitamin D analogs, such as calcipotriol, in the treatment of alopecia areata is inconsistent, and more studies are needed to determine their effectiveness 1.
- Oral zinc supplementation has also been studied as a potential treatment for alopecia areata, but the results have been inconsistent, and more research is needed to determine its effectiveness 1.
Psychological Support
Psychological support is also important for patients with alopecia areata, as the condition can cause significant emotional distress. Patients should be encouraged to avoid harsh hair treatments and protect the scalp from sun exposure during treatment.
- A multidisciplinary approach, including dermatological treatment and psychological support, is recommended for the management of alopecia areata 1.
From the Research
Diagnosis of Alopecia Areata
- Alopecia areata is an autoimmune disease leading to nonscarring hair loss on the scalp or body 2
- It is mostly diagnosed clinically 3
Treatment Options for Alopecia Areata
- Various treatment options are available, including topical, intralesional, and oral medications 3, 4
- Topical immunotherapy is the best documented treatment so far for severe and refractory alopecia areata 5
- Contact immunotherapy with diphenylcyclopropenone or squaric acid dibutyl ester is a preferred treatment for severe alopecia areata 6
- Janus kinase inhibitors, such as baricitinib, have shown promising results in treating alopecia areata 2, 4
- Other treatment options include:
- Systemic therapies (classical immunosuppressants, biologics, and small molecule inhibitors) 2
- Local therapies (intralesional corticosteroids, topical small molecule inhibitors, contact immunotherapy, hair growth stimulants, and cryotherapy) 2
- Topical bimatoprost 0.01% solution versus clobetasol propionate 0.05% cream 3
Efficacy of Treatment Options
- Baricitinib has been shown to increase short-term and long-term hair regrowth compared to placebo 2
- Topical immunotherapy has a response rate varying from 60% in severe alopecia areata to 17% in patients with alopecia totalis or universalis 5
- Contact immunotherapy has an overall rate of any hair regrowth of 65.5% among patients with alopecia areata 6
- Bimatoprost has an advantage of lesser side effects, more rapid response, and growth of more pigmented hairs compared to clobetasol propionate 3