Alopecia Areata: Treatment Options and Efficacy

December 2017 in “ Journal of the American Academy of Dermatology ”

Lauren C. Strazzulla, Eddy Hsi Chun Wang, Lorena Avila, Kristen Lo Sicco, Nooshin K. Brinster, Angela M. Christiano, Jerry Shapiro

TLDR Some treatments can help with a hair loss condition called alopecia areata, but none ensure lasting results; choices depend on the person, with JAK inhibitors showing promise for severe cases.

The January 2018 document reviews treatment options for alopecia areata (AA), noting that no treatments guarantee sustained remission and that treatment choices should be tailored to individual patient factors. It highlights Janus kinase (JAK) inhibitors as promising for severe AA and suggests an algorithm for integrating new treatments. Spontaneous remission rates for AA are reported between 8% and 68%. Intralesional corticosteroids, particularly triamcinolone acetonide (TAC), are first-line for limited AA, with a study showing 82.1% of 127 patients achieving over 50% improvement. Minoxidil is recommended as adjuvant therapy. A study of 32 patients showed 47% had more than 25% hair regrowth with a prednisone taper, and topical minoxidil maintained growth. Methotrexate was effective in 63% of patients with alopecia totalis (AT) or alopecia universalis (AU) when combined with oral corticosteroids, and 57% when used alone. Diphenylcyclopropenone (DPCP) had a 60% to 70% success rate for extensive AA. JAK inhibitors were effective but often led to recurrence after discontinuation, and their side effects can be serious. Other potential treatments being evaluated include statins and phosphodiesterase-4 inhibitors. The document is based on various studies, including follow-up studies, randomized controlled trials, and retrospective reviews.

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research Tofacitinib for the Treatment of Alopecia Areata and Variants in Adolescents

139 citations, November 2016 in “Journal of the American Academy of Dermatology”

Tofacitinib helped regrow hair in most adolescents with alopecia areata, but more research is needed.

research Tofacitinib for the Treatment of Severe Alopecia Areata and Variants: A Study of 90 Patients

238 citations, November 2016 in “Journal of The American Academy of Dermatology”

Tofacitinib is effective and safe for severe hair loss, but full regrowth is less likely after 10 years of hair loss.

research Oral Ruxolitinib Induces Hair Regrowth in Patients with Moderate-to-Severe Alopecia Areata

196 citations, September 2016 in “JCI insight”

Ruxolitinib effectively regrows hair in most patients with severe hair loss.

research Safety and Efficacy of the JAK Inhibitor Tofacitinib Citrate in Patients with Alopecia Areata

222 citations, September 2016 in “JCI insight”

Tofacitinib is safe and effective for severe alopecia areata, but hair loss may return 2 months after stopping treatment.

research Efficacy of Tofacitinib in Treatment of Alopecia Universalis in Two Patients

51 citations, June 2016 in “Journal of the European Academy of Dermatology and Venereology”

Tofacitinib was effective in treating hair loss in two patients with alopecia universalis.

research Topical Ruxolitinib for the Treatment of Alopecia Universalis

96 citations, December 2015 in “JAMA dermatology”

Topical Ruxolitinib may safely treat severe hair loss.

research Retrospective Review of Diphencyprone in the Treatment of Alopecia Areata

27 citations, December 2015 in “Clinical and Experimental Dermatology”

Diphencyprone helped most patients with alopecia areata regrow some hair.

research Treatment Options for Alopecia

17 citations, August 2015 in “Expert Opinion on Pharmacotherapy”

The document concludes that oral finasteride and topical minoxidil are effective for genetic hair loss, while other treatments for different types of hair loss show promise but need more research.

research Benefit of Different Concentrations of Intralesional Triamcinolone Acetonide in Alopecia Areata: An Intrasubject Pilot Study

50 citations, July 2015 in “Journal of the American Academy of Dermatology”

Using 2.5 mg/mL triamcinolone acetonide is effective for hair growth in alopecia areata with fewer side effects.

research Reversal of Alopecia Areata Following Treatment With the JAK1/2 Inhibitor Baricitinib

184 citations, February 2015 in “EBioMedicine”

A patient with Alopecia Areata had complete hair regrowth after using the drug baricitinib.

Efficacy and Safety of Diphenylcyclopropenone Alone or in Combination with Anthralin in the Treatment of Chronic Extensive Alopecia Areata: A Retrospective Case Series

research Efficacy and Safety of Diphenylcyclopropenone Alone or in Combination with Anthralin in the Treatment of Chronic Extensive Alopecia Areata: A Retrospective Case Series

44 citations, February 2015 in “Journal of the American Academy of Dermatology”

Combining diphenylcyclopropenone with anthralin is more effective for hair regrowth in alopecia areata than using diphenylcyclopropenone alone, but may cause more side effects.

research Treatment of Alopecia Areata with Squaric Acid Dibutylester

21 citations, December 2014 in “Clinics in dermatology”

Squaric acid dibutylester effectively treats alopecia areata.

research The PDE4 Inhibitor, Apremilast, Suppresses Experimentally Induced Alopecia Areata in Human Skin In Vivo

52 citations, December 2014 in “Journal of Dermatological Science”

Apremilast may help treat hair loss in alopecia areata.

research Alopecia Areata Is Driven by Cytotoxic T Lymphocytes and Is Reversed by JAK Inhibition

701 citations, August 2014 in “Nature medicine”

Alopecia areata can be reversed by JAK inhibitors, promoting hair regrowth.

research Killing Two Birds with One Stone: Oral Tofacitinib Reverses Alopecia Universalis in a Patient with Plaque Psoriasis

185 citations, June 2014 in “Journal of Investigative Dermatology”

A man with severe hair loss and skin disease regrew his hair with no side effects after taking tofacitinib.

A Randomized, Single-Blind Trial of 5% Minoxidil Foam Once Daily Versus 2% Minoxidil Solution Twice Daily in the Treatment of Androgenetic Alopecia in Women

research A Randomized, Single-Blind Trial of 5% Minoxidil Foam Once Daily Versus 2% Minoxidil Solution Twice Daily in the Treatment of Androgenetic Alopecia in Women

100 citations, June 2011 in “Journal of The American Academy of Dermatology”

5% minoxidil foam once daily works as well as 2% minoxidil solution twice daily for female hair growth and is more convenient.

research Camouflage Techniques for Alopecia Areata: What Is a Patient to Do?

19 citations, May 2011 in “Dermatologic Therapy”

The document suggests using hairpieces, wigs, and safe cosmetic techniques to hide hair loss from alopecia areata.

research Efficacy and Tolerability of Methotrexate in Severe Childhood Alopecia Areata

70 citations, April 2011 in “British journal of dermatology/British journal of dermatology, Supplement”

Methotrexate sometimes helps regrow hair in children with severe alopecia areata and is generally safe.

research Alopecia Areata Update

244 citations, January 2010 in “Journal of the American Academy of Dermatology”

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.