Advances in the management of alopecia areata
December 2011
in “The Journal of Dermatology”
TLDR New treatments for severe hair loss often fail, but some patients see hair regrowth with specific therapies, and treatment should be tailored to the individual's situation.
The 2011 document reviews the management of alopecia areata (AA), indicating that while up to 80% of patients with limited patchy AA may see spontaneous remission within a year, more severe cases like alopecia totalis/universalis (AT/AU) often do not improve and have high treatment failure rates. It outlines various treatments, including contact immunotherapy, corticosteroid therapies, antihistamines, photochemotherapy, and minoxidil, with high-dose corticosteroid therapy showing 67% of patients with recent-onset multifocal AA achieving over 50% hair regrowth. The Japanese guideline is introduced, offering treatment plans based on age and disease extent, and recommending different approaches for patients under and over 15 years old. The document emphasizes the importance of proper diagnosis and that treatment decisions should consider the patient's age, hair loss type, disease course, and personal preferences. It also notes the lack of robust trials for some therapies used in Japan, such as cryotherapy and carpronium chloride hydrate, despite the latter showing significant effects in a placebo-controlled randomized trial.
View this study on onlinelibrary.wiley.com →
Cited in this study
research Vertical vs. transverse sections of scalp biopsy specimens: a pilot study on the comparison of the diagnostic value of two techniques in alopecia
Transverse scalp sections are better for diagnosing non-scarring hair loss, while vertical sections are better for a specific scarring hair loss called lichen planopilaris.
research Vitiligo: A comprehensive overview
Vitiligo is a skin condition causing white spots, more common in women, often starts before age 20, and can affect mental health.
research Pigmented contact dermatitis due to therapeutic sensitizer as complication of contact immunotherapy in alopecia areata
Some patients with severe alopecia areata developed skin darkening from their treatment, which may indicate a less effective response to the therapy.
research Coudability hairs: a revisited sign of alopecia areata assessed by trichoscopy
research Alopecia areata update
The document says current treatments for alopecia areata do not cure or prevent it, and it's hard to judge their effectiveness due to spontaneous remission and lack of studies.
research Combination therapy with oral PUVA and corticosteroid for recalcitrant alopecia areata
research Scalp dermoscopy of androgenetic alopecia in Asian people
research Clinical significance of dermoscopy in alopecia areata: analysis of 300 cases
Dermoscopy helps diagnose and manage alopecia areata by showing specific hair changes.
research Minoxidil: mechanisms of action on hair growth
Minoxidil boosts hair growth by opening potassium channels and increasing cell activity.
research Guidelines for the management of alopecia areata
The 2003 guidelines suggest that while some treatments can regrow hair in alopecia areata, none alter the disease's progression, and wigs may be the best option for extensive hair loss.
research Clobetasol propionate 0.05% under occlusion in the treatment of alopecia totalis/universalis
Clobetasol propionate ointment can help some people with total hair loss regrow hair.
research Acute Diffuse and Total Alopecia of the Female Scalp
A new type of sudden, complete female hair loss was found, with most patients fully recovering within 6 months without needing steroid treatment.
research Minoxidil upregulates the expression of vascular endothelial growth factor in human hair dermal papilla cells
Minoxidil boosts growth factor in hair cells, potentially promoting hair growth.
research PUVA treatment of alopecia areata partialis, totalis and universalis: audit of 10 years' experience at St John's Institute of Dermatology
research Systemic Steroids With or Without 2% Topical Minoxidil in the Treatment of Alopecia Areata
Steroids help hair regrowth, and minoxidil slows post-steroid hair loss, but effects are temporary.
research Topical Minoxidil in Alopecia Areata: No Effect on the Perifollicular Lymphoid Infiltration
Minoxidil doesn't affect perifollicular lymphoid infiltration in alopecia areata patients.
research The Effect of Topical Minoxidil on Hair Follicular Cycles of Rats
Minoxidil speeds up hair growth in rats without prolonging growth phase.
research Alterations in scalp blood flow after the epicutaneous application of 3% minoxidil and 0.1% hexyl nicotinate in alopecia
Minoxidil didn't increase scalp blood flow for hair growth, but hexyl nicotinate did.
research Double-blind, placebo-controlled evaluation of topical minoxidil in extensive alopecia areata
Minoxidil helps hair growth in 63.6% of alopecia patients, with 27.3% having excellent results.
research Action of topical minoxidil in the bald stump-tailed macaque
Minoxidil promotes hair growth but stops working when discontinued.
research Minoxidil Stimulates Cutaneous Blood Flow in Human Balding Scalps: Pharmacodynamics Measured by Laser Doppler Velocimetry and Photopulse Plethysmography
Minoxidil increases blood flow in balding scalps, possibly reversing hair loss.
Related
research Alopecia areata: A multifactorial autoimmune condition
Alopecia areata is an autoimmune disease causing patchy hair loss, often with other autoimmune disorders, but its exact causes are unknown.
research Linear alopecia areata
research Treating of resistant cases of alopecia universalis
Combining platelet-rich plasma therapy with prostaglandin-F eye drops can significantly regrow hair in alopecia universalis.