Alopecia Areata

Alopecia Areata – Treatment Overview

Introduction
Alopecia areata is an autoimmune disorder in which T-lymphocytes attack hair follicles, leading to non-scarring, patchy hair loss on the scalp, beard, or body. It may progress to alopecia totalis (loss of all scalp hair) or alopecia universalis (loss of all body hair). The condition often has an unpredictable course, with spontaneous regrowth possible in some patients, while others experience chronic or relapsing disease. The main goals of treatment are to suppress the autoimmune response, stimulate hair regrowth, and improve the patient’s psychological well-being.

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Treatment Options and Doses

1. First-Line (Localized Disease)

• Intralesional corticosteroids (gold standard for patchy alopecia areata):

  • Triamcinolone acetonide 2.5–10 mg/mL injected intradermally into patches every 4–6 weeks.

  • Maximum total dose: usually ≤40 mg per session.

• Topical corticosteroids (high potency, e.g., clobetasol propionate 0.05% cream/foam):

  • Apply to affected areas once or twice daily.

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2. Second-Line (Extensive or Rapidly Progressive Disease)

• Systemic corticosteroids (short-term):

  • Prednisolone: 0.5–1 mg/kg/day orally for 4–6 weeks, followed by tapering.

  • Used for severe, rapidly progressive alopecia areata, but long-term risks limit routine use.

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3. Immunotherapy

• Topical immunotherapy (to induce controlled allergic contact dermatitis):

  • Diphenylcyclopropenone (DPCP) or Squaric acid dibutyl ester (SADBE) applied weekly under specialist supervision.

  • Goal: stimulate immune diversion and promote hair regrowth.

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4. Janus Kinase (JAK) Inhibitors (Newer Therapy)

• Baricitinib (FDA-approved for severe alopecia areata):

  • Adults: 2 mg orally once daily; may increase to 4 mg once daily if inadequate response.

• Tofacitinib (off-label in some regions):

  • Adults: 5 mg orally twice daily.

• Ruxolitinib (off-label):

  • 20 mg orally twice daily in clinical use.

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5. Adjunctive and Supportive Measures

• Minoxidil topical (2% or 5% solution/foam):

  • Apply 1 mL to affected areas twice daily; mainly as adjunctive therapy.

• Phototherapy (PUVA, excimer laser): In resistant cases, with variable response.

• Psychological support: Counseling or support groups for stress and self-image concerns.

• Cosmetic aids: Wigs, hairpieces, or camouflage sprays.