Tips
- Educate the patient about the chronic relapsing nature of alopecia areata.
- Reassure patients that the condition is benign and does not threaten their general health.
- The condition is highly unpredictable in presentation, evolution, and response to treatment.
- Consider full blood count, thyroid function tests, serum B12 and autoantibodies as a screen for associated autoimmune conditions.
- No treatment remains a therapeutic option especially in young children as spontaneous hair regrowth occurs in up to 80% of patients with limited patchy hair loss and in less than one year duration.
- Psychological assessment and management should be considered.
Medical treatment options
Limited patchy alopecia
- Topical corticosteroids
- Fluocinolone acetonide cream 0.2% twice per day.
- Betamethasone dipropionate cream 0.05% once daily.
- Clobetasol (lotion, foam or shampoo ) may be under occlusion .
- For beard and eyebrow alopecia areta, long term use of high-potency topical corticosteroids is not advisable because of the potential for corticosteroid-induced skin atrophy.
- Intralesional steroids : Triamcinolone acetonide 2.5–10 mg/mL or hydrocortisone acetate 25 mg/mL
- Application of topical anesthetic cream for 2 hrs under occulsion with a plastic wrab to be removed just before the injection
- One session every 3-4 wks.
- For scalp, 5 mg/mL (maximum volume of 3 mL per session) is the preferred concentration.
- For the eyebrows and face, 2.5 mg/mL can be used.
- Less than 0.1 mL is injected per site , about 1 cm between injection sites, not to inject more than 20 mg in total at one visit.
- After 6 months, discontinue injection If there is no response.
- Intralesional steroid will not prevent the development of alopecia at other sites and is not suitable for patients with rapidly progressive alopecia or alopecia totalis/universalis
- Topical minoxidil (2% or 5%).
- Topical anthralin (0.5–1% )cream applied daily for 20 to 30 minutes to be increased by 10 minutes every 2 wks up to one hour followed by washing the affected area with lukewarm water and shampoo.
- Topical Tofacitinib 2%.
Extensive and rapidly progressive alopecia areata
Topical
- Topical immunotherapy
- Contact immunotherapy by dinitrochlorobenzene (DNCB), squaric acid dibutylester (SADBE) and diphenylcyclopropenone (DPCP) once per week.
- Topical corticosteroids
- Clobetasol propionate 2.5 g under occlusion 6 d/wk for 6 months.
Systemic
- Methylprednisolone : 500 mg/day for 3 days or 5 mg/kg twice a day over 3 days.
- Triamcinolone : 40 mg Im monthly.
- Prednisone: 40 -60 mg per kg
- Prednisolone: 200 mg once a week for 3 months.(Ref)
- Methotrexate :15–25 mg/ week.
- Cyclosporine: 2.5-6 mg/kg/d.
- Tofacitinib : 5 mg twice daily to be increased by 5 mg per month.
- Zinc gluconate : 30-50 mg/day
Eye lid AA
- Latanoprost 0.005% to the eyelid margins every night.
- Bimatoprost 0.03% eye drops once a day on to the eyelid margins for 1 year.
Physical treatment options
- PUVA ( 20-40 treatments ).
- Excimer laser: twice weekly.
- Platelet-rich plasma
Cosmetic treatment
- Wearing a wig.
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