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.
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.