British Association of Dermatologists Living Guideline for Managing People with Alopecia Areata 2024

October 2024 in “ British Journal of Dermatology ”

Matthew Harries, Anna Ascott, Leila Asfour, Paul Farrant, Gordon Hale, Susan Holmes, Amy J. Johnson, Victoria Jolliffe, Ahmed Kazmi, A. E. Macbeth, Andrew G. Messenger, Ali Noor, Anita Takwale, Andrew R. Thompson, Maria Hashme, L. Manounah, M.F. Mohd Mustapa, Alina M Constantin

alopecia areata alopecia totalis alopecia universalis patchy baldness

TLDR The guideline provides recommendations for managing alopecia areata effectively.

The British Association of Dermatologists' 2024 guideline for managing alopecia areata (AA) provides comprehensive, evidence-based recommendations for treating this condition, which causes patchy hair loss and can progress to more severe forms. Developed by a diverse group of experts, the guideline emphasizes a holistic approach, considering both physical and psychological impacts, and includes 49 management recommendations. Key aspects include using the SALT score for severity assessment, addressing psychological distress, and considering individual patient needs. Treatment options range from topical corticosteroids to systemic therapies like Janus kinase inhibitors, with a focus on balancing benefits and risks. The guideline also highlights the importance of early intervention, ongoing research, and the potential association of AA with other autoimmune disorders. It is designed to be updated regularly and is accessible on the BAD website.

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Research cited in this study

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research The Alopecia Areata Severity And Morbidity Index (ASAMI) Study

21 citations , February 2024 in “JAMA Dermatology”

Alopecia areata severity is influenced by factors like long disease duration, relapses, treatment response, and mental health, leading to the creation of a new severity measurement tool.

Expecting Scalp Hair Regrowth During Severe Alopecia Areata Treatment with Baricitinib: Insights from Patient Trajectories in Phase III Trials

research Expecting Scalp Hair Regrowth During Severe Alopecia Areata Treatment with Baricitinib: Insights from Patient Trajectories in Phase III Trials

September 2023 in “British Journal of Dermatology”

Hair regrowth from severe alopecia areata treatment with baricitinib can vary, with faster results in those with shorter hair loss duration.

research Alopecia Areata and Risk of Atopic and Autoimmune Conditions: Population-Based Cohort Study

34 citations , November 2022 in “Clinical and Experimental Dermatology”

People with alopecia areata are more likely to have other immune-related conditions.

research Analysis of Alopecia Areata Surveys Suggests a Threshold for Improved Patient-Reported Outcomes

14 citations , June 2022 in “British Journal of Dermatology”

A SALT score of ≤ 20 indicates meaningful improvement in alopecia areata treatment.

research The Associated Burden of Mental Health Conditions in Alopecia Areata: A Population-Based Study in UK Primary Care

20 citations , February 2022 in “British Journal of Dermatology”

People with alopecia areata have a higher risk of depression and anxiety, and often face unemployment and work absences.

research Validation of the Alopecia Areata Patient Priority Outcomes Questionnaire in Adults and Adolescents with Alopecia Areata

22 citations , November 2021 in “Dermatology and Therapy”

The AAPPO questionnaire is a reliable tool for assessing hair loss impact in alopecia areata patients.

Development of Clinician-Reported Outcome and Patient-Reported Outcome Measures for Eyebrow, Eyelash, and Nail Assessment in Alopecia Areata

research Development of Clinician-Reported Outcome and Patient-Reported Outcome Measures for Eyebrow, Eyelash, and Nail Assessment in Alopecia Areata

56 citations , August 2020 in “American Journal of Clinical Dermatology”

New tools help assess eyebrow, eyelash, and nail changes in Alopecia Areata, improving understanding of patient experiences.

research The Alopecia Areata Investigator Global Assessment Scale: A Measure for Evaluating Clinically Meaningful Success in Clinical Trials

86 citations , January 2020 in “British Journal of Dermatology”

The AA-IGA scale reliably measures treatment success in alopecia areata by considering both clinician and patient views.

research Combination Tofacitinib and Oral Minoxidil Treatment for Severe Alopecia Areata

23 citations , September 2019 in “Journal of The American Academy of Dermatology”

Tofacitinib and oral minoxidil together effectively regrow hair in severe alopecia areata patients.

research All-Cause and Cause-Specific Mortality Risks Associated With Alopecia Areata

19 citations , May 2019 in “JAMA dermatology”

People with alopecia areata have similar overall death rates as others but higher risks of death from self-harm, psychiatric issues, and lung cancer in certain cases.

research Assessment of a Bidirectional Association Between Major Depressive Disorder and Alopecia Areata

37 citations , January 2019 in “JAMA Dermatology”

People with Major Depressive Disorder have a higher chance of getting Alopecia Areata, and vice versa; antidepressants may lower this risk.

research Alopecia Areata: A Review of Disease Pathogenesis

191 citations , May 2018 in “British journal of dermatology/British journal of dermatology, Supplement”

Alopecia areata is likely an autoimmune disease with unclear triggers, involving various immune cells and molecules, and currently has no cure.

research Alopecia Areata Is Associated With Increased Expression of Heart Disease Biomarker Cardiac Troponin I

19 citations , January 2018 in “Acta dermato-venereologica”

People with alopecia areata have higher levels of a heart disease marker than those without hair loss.

research Screening Guidelines for Thyroid Function in Children With Alopecia Areata

35 citations , October 2017 in “JAMA dermatology”

Children with alopecia areata should only have thyroid screening if they have Down syndrome, a history of atopy, family history of thyroid disease, or signs of thyroid problems.

research Changes of Serum Trace Elements Level in Patients with Alopecia Areata: A Meta-Analysis

23 citations , February 2017 in “Journal of dermatology”

Low serum levels of zinc and selenium may increase the risk of alopecia areata.

research Estimated Serum Vitamin D Status, Vitamin D Intake, and Risk of Incident Alopecia Areata Among US Women

23 citations , September 2016 in “Archives of Dermatological Research”

Vitamin D levels do not affect the risk of developing alopecia areata.

research Nutrition and Skin: Children Are Not Just Little Adults

18 citations , July 2016 in “Clinics in dermatology”

Nutrition affects skin health differently based on age and condition.

research Genomewide Analysis of Copy Number Variants in Alopecia Areata in a Central European Cohort Reveals Association with MCHR2

29 citations , June 2016 in “Experimental Dermatology”

MCHR2 gene duplications may be linked to alopecia areata.

research Cardiovascular Risk in Patients with Alopecia Areata: A Propensity-Matched Retrospective Analysis

29 citations , May 2016 in “Journal of the American Academy of Dermatology”

Patients with alopecia areata might have a lower risk of stroke and possibly heart attack.

research Functional Interpretation of Genome-Wide Association Study Evidence in Alopecia Areata

55 citations , October 2015 in “Journal of Investigative Dermatology”

Alopecia areata is linked to immune-related genes, suggesting JAK inhibitors as a potential treatment.

research Alopecia Areata Increases the Risk of Stroke: A 3-Year Follow-Up Study

25 citations , June 2015 in “Scientific Reports”

People with alopecia areata have a higher risk of stroke.

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 Vitamin D Deficiency in Alopecia Areata

105 citations , March 2014 in “British journal of dermatology/British journal of dermatology, Supplement”

Alopecia areata patients often have low vitamin D levels, suggesting they might benefit from vitamin D supplements.

research The Role of Hair Follicle Immune Privilege Collapse in Alopecia Areata: Status and Perspectives

79 citations , December 2013 in “Journal of Investigative Dermatology Symposium Proceedings”

Alopecia areata may be treated by restoring hair follicle immune privilege and adjusting immune responses.

research Reduced Level of 25-Hydroxyvitamin D in Chronic/Relapsing Alopecia Areata

40 citations , April 2013 in “Dermato-endocrinology”

People with chronic Alopecia Areata often have lower vitamin D levels.

research Early Intervention with High-Dose Steroid Pulse Therapy Prolongs Disease-Free Interval of Severe Alopecia Areata: A Retrospective Study

19 citations , January 2013 in “Annals of Dermatology”

Early high-dose steroid treatment helps prolong disease-free periods in severe alopecia areata.

research British Association of Dermatologists’ Guidelines for the Management of Alopecia Areata 2012

218 citations , April 2012 in “British Journal of Dermatology”

Guidelines suggest various treatments for alopecia areata, but leaving it untreated is also an option as 80% cases may recover on their own.

research Genome-Wide Association Study in Alopecia Areata Implicates Both Innate and Adaptive Immunity

717 citations , June 2010 in “Nature”

Alopecia areata involves both innate and adaptive immunity, with specific genes linked to the disease.

research Alopecia Areata Update

391 citations , January 2010 in “Journal of The American Academy of Dermatology”

Half of people with Alopecia Areata may see hair regrowth within a year without treatment, but recovery is unpredictable.

research Probing the Effects of Stress Mediators on the Human Hair Follicle

159 citations , December 2007 in “American Journal of Pathology”

Stress-related substance P may lead to hair loss and negatively affect hair growth.

research Acute Diffuse and Total Alopecia of the Female Scalp

59 citations , January 2002 in “Dermatology”

A new type of sudden, complete female hair loss was found, with most patients fully recovering within 6 months without needing steroid treatment.

research The Pathogenesis of Alopecia Areata

89 citations , October 1996 in “Dermatologic Clinics”

Alopecia areata is likely caused by a combination of genetic factors and immune system dysfunction, and may represent different diseases with various causes.

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

101 citations , November 1992 in “Archives of Dermatology”

Steroids help hair regrowth, and minoxidil slows post-steroid hair loss, but effects are temporary.