Alopecia Areata: Treatment Options and Efficacy

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.