What is the treatment for a 71-year-old female with central alopecia (hair loss) that has persisted for 2 years?

From the Guidelines

For a 71-year-old female with central alopecia persisting for 2 years, I recommend starting with 0.05% clobetasol propionate foam applied to the affected area, as it has shown to be effective in promoting hair regrowth in patients with alopecia areata 1. This treatment option is based on the most recent and highest quality study available, which demonstrated that more sites treated with clobetasol had at least 50% regrowth of hair compared to the vehicle-treated sites. Some key points to consider when using this treatment include:

• Apply the foam to the affected area and gently massage it in
• Use the treatment for at least 12 weeks to assess its effectiveness
• Be aware of potential side effects, such as folliculitis, which is a common side-effect of treatment with potent topical steroids
• Consider alternative treatment options, such as intralesional corticosteroids or wigs, if the patient does not respond to topical treatment or experiences significant side effects It is also important to note that the patient's age and duration of alopecia areata may impact the effectiveness of the treatment, and regular follow-up appointments should be scheduled to monitor progress and adjust the treatment plan as needed. Before initiating treatment, obtain baseline laboratory tests including complete blood count, comprehensive metabolic panel, thyroid function tests, iron studies, and vitamin D levels to rule out underlying medical causes. If no improvement occurs after 6 months of consistent use, consider referral to a dermatologist for possible scalp biopsy to confirm diagnosis and explore additional treatments such as platelet-rich plasma injections or low-level laser therapy.

From the Research

Diagnosis and Treatment of Female Central Alopecia

• Female central alopecia can be caused by various factors, including androgenetic alopecia, alopecia areata, and scarring alopecia such as central centrifugal cicatricial alopecia (CCCA) 2, 3.
• A 71-year-old patient with central alopecia for 2 years may require a thorough evaluation and diagnosis by a dermatologist to determine the underlying cause of the condition 4.
• The diagnosis of alopecia areata, a common cause of hair loss, can be made clinically and treated with minoxidil, while scarring alopecia such as CCCA may require more aggressive treatment and evaluation by a dermatologist 2, 3.

Associated Autoimmune Diseases

• Alopecia areata has been associated with other autoimmune diseases, including thyroid disorders, atopic dermatitis, and anemias 5.
• A study found that thyroid disorders, particularly hypothyroidism, were significantly associated with alopecia areata, with an odds ratio of 3.2 and a P value of 0.01 5.
• Seborrheic dermatitis has also been identified as a potential trigger for central centrifugal cicatricial alopecia, particularly in African American women 3.

Treatment Options

• Treatment options for female central alopecia depend on the underlying cause of the condition and may include minoxidil, systemic treatments for autoimmune diseases, and avoidance of hair styling practices that can cause trauma to the hair shaft 2, 4.
• A dermatologist can help determine the best course of treatment for a patient with central alopecia, taking into account the patient's medical history, age, and other factors 4.