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

From the encyclopedia

Alopecia Areata →

autoimmune disorder causing patchy hair loss

Triamcinolone Acetonide →

Minoxidil →

An essential vasodilator with some anti-androgenic effects

Studysummary This article reviews current and emerging treatments for alopecia areata, including Janus kinase inhibitors, highlighting variability in clinical outcomes and the lack of sustained remission. Our plain-language summary of this paper — not a Tressless recommendation.

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 cited in this study

31 / 31 results

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

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

In this retrospective review, tofacitinib treatment was associated with clinically significant hair regrowth in most adolescent patients with alopecia areata, though limitations suggest further studies are needed to confirm these findings.

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”

In this study, tofacitinib was reported to improve scalp hair regrowth in patients with severe alopecia areata, alopecia totalis, and alopecia universalis, showing a higher response in alopecia areata.

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

222 citations , September 2016 in “JCI insight”

This research overview highlights that although JAK inhibitors show promise as potential treatments for alopecia areata based on recent insights into the disease mechanism, their efficacy has not yet been thoroughly evaluated in a systematic manner.

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

196 citations , September 2016 in “JCI insight”

This study explored the effectiveness of the oral JAK1/2 inhibitor ruxolitinib in treating patients with moderate-to-severe alopecia areata, building on prior success with JAK inhibitors in mice, but results are not reported in this abstract.

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”

In this study, tofacitinib treatment was associated with significant hair regrowth in two patients with alopecia universalis over eight months, with minimal adverse effects reported.

research Topical Ruxolitinib for the Treatment of Alopecia Universalis

96 citations , December 2015 in “JAMA dermatology”

This article discusses the potential of topical ruxolitinib as a treatment for alopecia universalis and acknowledges the need for alternatives to systemic JAK inhibitors due to the risk of serious side effects.

research Retrospective Review of Diphencyprone in the Treatment of Alopecia Areata

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

This study found that hair regrowth occurred in 72.2% of alopecia areata patients treated with diphencyprone, with disease extent at baseline and duration affecting outcomes.

research Treatment Options for Alopecia

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

This article discusses the social and psychological impact of hair disorders and the challenges in their treatment, but reports no new clinical results.

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”

This study found that 2.5 mg/mL triamcinolone acetonide injections were as effective as higher doses for treating limited, patchy alopecia areata, while minimizing side effects like skin atrophy.

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

184 citations , February 2015 in “EBioMedicine”

This study observed that baricitinib treatment led to significant improvement in a patient's alopecia areata symptoms and suggests further clinical trials to explore its potential as a treatment.

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”

This study found that combination therapy with diphenylcyclopropenone and anthralin was more effective for complete hair regrowth in chronic extensive alopecia areata than diphenylcyclopropenone alone, despite more common side effects.

research Treatment of Alopecia Areata with Squaric Acid Dibutylester

21 citations , December 2014 in “Clinics in dermatology”

This review discusses squaric acid dibutylester's use, effects, and safety in treating alopecia areata, but reports no new clinical results.

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”

This study found that JAK inhibitors promote hair regrowth in both mice and human alopecia areata cases by blocking key immune pathways involved in disease development.

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”

This case report describes complete hair regrowth in a patient with alopecia universalis and improved psoriasis after treatment with the oral Janus kinase inhibitor, 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”

This study found that a once-daily 5% minoxidil topical foam is as effective as a twice-daily 2% minoxidil topical solution for hair growth in women with androgenetic alopecia, with fewer side effects and greater styling convenience.

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

19 citations , May 2011 in “Dermatologic Therapy”

This article discusses various options for camouflaging hair loss involving the scalp, eyebrows, and eyelashes, and reports no new clinical findings.

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”

This retrospective study found that methotrexate had variable efficacy in treating severe alopecia areata in children, with successful hair regrowth observed in five out of thirteen assessable cases.

research Alopecia Areata Update

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

This review discusses treatment options for alopecia areata and suggests tailored treatment plans, noting the challenges posed by spontaneous remission and limited high-quality clinical trials.

research Treatment of Severe Alopecia Areata with Intralesional Steroid Injections

60 citations , October 2009 in “PubMed”

This study reports that intralesional triamcinolone acetonide was effective and well-tolerated for treating extensive alopecia areata in patients who often showed specific initial hair characteristics.

research Efficacy And Safety Of A New Clobetasol Propionate 0.05% Foam In Alopecia Areata: A Randomized, Double-Blind Placebo-Controlled Trial

114 citations , October 2006 in “Journal of the European Academy of Dermatology and Venereology”

In this study, clobetasol propionate foam demonstrated effectiveness and good patient compliance as a safe topical treatment for moderate to severe alopecia areata, with significant hair regrowth compared to placebo.

research Clobetasol Propionate 0.05% Under Occlusion in the Treatment of Alopecia Totalis/Universalis

146 citations , July 2003 in “Journal of the American Academy of Dermatology”

In this study, clobetasol propionate 0.05% ointment was found to induce hair regrowth in 28.5% of patients with severe alopecia areata under occlusive conditions, though long-term benefit was limited to 17.8%.

research Hypertrichosis in Females Applying Minoxidil Topical Solution and in Normal Controls

63 citations , April 2003 in “Journal of The European Academy of Dermatology and Venereology”

This study found that minoxidil topical solution was associated with a dose-related occurrence of hypertrichosis, especially facial hair, in women treated for androgenetic alopecia.

research The Pattern and Profile of Alopecia Areata in Singapore: A Study of 219 Asians

275 citations , November 2002 in “International Journal of Dermatology”

This study found that among an Asian population with alopecia areata, commonly first episodes occurred before age 40, with severe cases linked to psychological effects and treatments showing significant regrowth.

research Efficacy of Topical Sensitizers in the Treatment of Alopecia Areata

132 citations , November 1998 in “Journal of the American Academy of Dermatology”

This review evaluates the efficacy and safety of topical sensitizers in treating alopecia areata but reports no new clinical findings.

Treatment of Chronic Severe Alopecia Areata with Topical Diphenylcyclopropenone and 5% Minoxidil: A Clinical and Immunopathologic Evaluation

research Treatment of Chronic Severe Alopecia Areata with Topical Diphenylcyclopropenone and 5% Minoxidil: A Clinical and Immunopathologic Evaluation

41 citations , November 1993 in “Journal of The American Academy of Dermatology”

This study found that DPCP treatment led to cosmetically acceptable hair regrowth in 38% of patients with chronic severe alopecia areata, while adding 5% minoxidil showed no significant clinical benefit.

Systemic Steroids With or Without 2% Topical Minoxidil in the Treatment of Alopecia Areata