Treatment of Alopecia Areata: An Australian Expert Consensus Statement

Alopecia areata (AA) severity ranged from a single small patch to complete loss of all hair, with 40% of individuals experiencing spontaneous remission within 6 months, 27% within 12 months, and 33% developing chronic AA. Without systemic treatment, 55% of chronic AA cases had persistent multifocal disease, 30% developed alopecia totalis, and 15% developed alopecia universalis. The condition's unpredictable course and psychological impact contributed to its associated illness. Various topical, intralesional, and systemic treatments were used, but data on their effectiveness and tolerability were limited. Topical treatments were suitable for limited disease, while systemic treatments were considered for rapid, extensive, or chronic hair loss, or severe distress. Systemic treatments included glucocorticosteroids, methotrexate, and others, but an optimal treatment algorithm had not been established. The consensus statement aimed to outline a treatment algorithm, including indications for systemic treatment, choice of treatment, outcome measures, and guidelines for discontinuing treatment.