From the Guidelines
Management of scalp alopecia areata typically begins with topical corticosteroids as first-line therapy, particularly for limited disease, with high-potency options like clobetasol propionate 0.05% foam or solution applied twice daily for 12 weeks being recommended. This approach is supported by the British Association of Dermatologists' guidelines for the management of alopecia areata 2012 1, which suggests that very potent topical steroids are widely used to treat alopecia areata, although the evidence for their effectiveness is limited.
For more extensive disease, intralesional corticosteroid injections using triamcinolone acetonide (5-10 mg/ml) administered every 4-6 weeks directly into affected areas can be effective, as reported in the British Association of Dermatologists' guidelines for the management of alopecia areata 2012 1. Minoxidil 5% solution applied twice daily may be added as an adjunct therapy to stimulate hair regrowth.
In severe or refractory cases, systemic treatments should be considered, including oral corticosteroids, JAK inhibitors like tofacitinib, or immunosuppressants such as methotrexate, as these treatments work by suppressing the autoimmune response that causes hair follicle inflammation and disrupts the normal hair growth cycle 1. Phototherapy with PUVA or excimer laser can also be beneficial for some patients.
Patient education about the chronic, relapsing nature of alopecia areata is essential, and psychological support should be offered as the condition can significantly impact quality of life, as emphasized in the British Association of Dermatologists' guidelines for the management of alopecia areata 2012 1. Some patients may require referral to a pediatric clinical psychologist, educational psychologist, or social worker, especially children who may be profoundly affected by their alopecia.
Key considerations in managing scalp alopecia areata include:
- Topical corticosteroids as first-line therapy for limited disease
- Intralesional corticosteroid injections for more extensive disease
- Adjunct therapy with minoxidil to stimulate hair regrowth
- Systemic treatments for severe or refractory cases
- Phototherapy as a beneficial option for some patients
- Patient education and psychological support to address the chronic and relapsing nature of the condition and its impact on quality of life.
From the Research
Management of Scalp Alopecia Areata
The management of scalp alopecia areata involves various treatment options, including topical, systemic, and injectable interventions.
- Current treatments show varying response and frequent relapses, reflecting the unmet clinical need 2.
- Traditional therapies include topical corticosteroids, such as clobetasol propionate 0.05% under occlusion, which has been shown to be effective in inducing hair regrowth in patients with alopecia totalis or universalis 3.
- Systemic steroids, such as prednisone, have also been used in combination with 2% topical minoxidil to treat alopecia areata, with some patients experiencing significant hair regrowth 4.
- Emerging therapies, including Janus kinase inhibitors, such as baricitinib and ritlecitinib, have shown promise in treating severe alopecia areata cases 5.
- Microneedle injection of minoxidil combined with triamcinolone acetonide has also been shown to be a safe and effective method for treating alopecia areata, with significant improvements in hair regrowth and quality of life 6.
Treatment Options
Treatment options for scalp alopecia areata include:
- Topical corticosteroids, such as clobetasol propionate 0.05% under occlusion 3
- Systemic steroids, such as prednisone, in combination with 2% topical minoxidil 4
- Microneedle injection of minoxidil combined with triamcinolone acetonide 6
- Janus kinase inhibitors, such as baricitinib and ritlecitinib 5
Psychosocial Aspects
The psychosocial aspects of alopecia areata should not be overlooked, as the disease can have a significant impact on a patient's quality of life, causing depression and anxiety 2.
- Patients with alopecia areata may require psychological support and counseling to address these issues.
- Healthcare providers should be aware of the potential psychosocial burden of the disease and provide appropriate support and resources to patients.