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

April 2012 in “ British Journal of Dermatology ”

Andrew G. Messenger, James H. McKillop, P Farrant, Andrew J. G. McDonagh, M.J. Sladden

alopecia areata topical corticosteroids systemic corticosteroids contact immunotherapy photochemotherapy minoxidil dithranol calcineurin inhibitors prostaglandin F₂α analogues synthetic acrylic wigs monofilament acrylic wigs false eyelashes false eyebrows Rogaine

From the encyclopedia

Alopecia Areata →

autoimmune disorder causing patchy hair loss

Minoxidil →

An essential vasodilator with some anti-androgenic effects

Studysummary This updated guideline from the British Association of Dermatologists discusses current recommendations for managing alopecia areata but reports no new clinical research findings.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

The British Association of Dermatologists released guidelines for the management of alopecia areata in 2012. The guidelines cover various treatments, including topical and systemic corticosteroids, contact immunotherapy, photochemotherapy, minoxidil, dithranol, calcineurin inhibitors, and prostaglandin F₂α analogues. The guidelines recommend leaving alopecia areata untreated as a legitimate option for many patients, as spontaneous remission occurs in up to 80% of cases. Synthetic acrylic wigs are recommended as the most affordable option, while monofilament acrylic wigs are constructed to give the appearance of hair growing from the scalp. False eyelashes and eyebrows can be synthetic or human hair, and top lashes can easily be purchased. Overall, the document aims to provide dermatologists with evidence-based recommendations for the management of alopecia areata.

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Research cited in this study

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

717 citations , June 2010 in “Nature”

This study identified key genetic regions associated with alopecia areata, highlighting both acquired and innate immune involvement, with a novel link to the upregulation of ULBP ligands in autoimmune disease.

research Alopecia Areata as Another Immune-Mediated Disease Developed in Patients Treated with Tumor Necrosis Factor-Alpha Blocker Agents

61 citations , June 2010 in “Journal of the European Academy of Dermatology and Venereology”

This study highlights cases of alopecia areata that developed during anti-TNF-α therapy, suggesting a potential link or increased frequency, particularly among individuals with a personal or family history of autoimmune diseases.

research Latanoprost in the Treatment of Eyelash Alopecia in Alopecia Areata Universalis

50 citations , December 2009 in “Journal of The European Academy of Dermatology and Venereology”

This study found that latanoprost may be effective for treating eyelash alopecia areata, achieving cosmetically acceptable regrowth in 45% of patients.

research Alefacept for Severe Alopecia Areata: A Multicenter, Double-Blind, Randomized, Placebo-Controlled Clinical Trial

43 citations , November 2009 in “Archives of dermatology”

This study found that alefacept showed no significant improvement in treating severe alopecia areata compared to placebo over a 24-week period.

research 308-nm Excimer Laser for the Treatment of Alopecia Areata in Children

79 citations , September 2009 in “Pediatric dermatology”

This study found that the 308-nm Excimer laser was effective and safe for treating patchy alopecia areata in children, with hair regrowth observed in 60% of treated scalp patches.

Lack of Efficacy of Topical Latanoprost and Bimatoprost Ophthalmic Solutions in Promoting Eyelash Growth in Patients with Alopecia Areata

research Lack of Efficacy of Topical Latanoprost and Bimatoprost Ophthalmic Solutions in Promoting Eyelash Growth in Patients with Alopecia Areata

55 citations , March 2009 in “Journal of The American Academy of Dermatology”

This study found that latanoprost and bimatoprost, when applied cutaneously to the eyelids, did not induce appreciable eyelash regrowth in patients with alopecia areata over 16 weeks.

research Treatment of Persistent Alopecia Areata with Sulfasalazine

45 citations , July 2008 in “International Journal of Dermatology”

This study found that oral sulfasalazine led to varying hair regrowth outcomes in patients with persistent alopecia areata, with 56.3% showing moderate to good responses.

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 Intralesional Treatment of Alopecia Areata with Triamcinolone Acetonide by Jet Injector

100 citations , July 2006 in “British Journal of Dermatology”

This study found that intralesional triamcinolone acetonide injections using a needleless injector led to rapid hair regrowth in patients with limited alopecia areata, while lasting growth was rare in alopecia totalis.

research Use of the Pulsed Infrared Diode Laser (904 nm) in the Treatment of Alopecia Areata

63 citations , January 2006 in “Journal of cosmetic and laser therapy”

This study found that pulsed infrared diode laser therapy (904 nm) was effective in promoting hair regrowth in 94% of patients with resistant patches of alopecia areata.

research Placebo-Controlled Oral Pulse Prednisolone Therapy in Alopecia Areata

141 citations , February 2005 in “Journal of the American Academy of Dermatology”

In this study, oral prednisolone pulse therapy led to significant hair regrowth in some patients with extensive alopecia areata, whereas no improvement was seen in the placebo group.

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 Sulfasalazine for Alopecia Areata

62 citations , April 2002 in “Journal of the American Academy of Dermatology”

In this study, sulfasalazine treatment resulted in cosmetically acceptable hair regrowth in 23% of patients with severe alopecia areata in whom a response could be determined.

research Twice Weekly 5 mg Dexamethasone Oral Pulse in the Treatment of Extensive Alopecia Areata

65 citations , September 1999 in “The Journal of Dermatology”

In this study, complete to excellent hair regrowth was observed in 63.3% of patients with extensive alopecia areata treated with biweekly dexamethasone pulses, although mild side effects were frequent.

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.

research Randomized Trial of Aromatherapy for Alopecia Areata

122 citations , November 1998 in “Archives of Dermatology”

This study found that aromatherapy involving essential oils significantly improved symptoms of alopecia areata compared to carrier oils alone in a randomized controlled trial.

research The Pathogenesis of Alopecia Areata

89 citations , October 1996 in “Dermatologic Clinics”

This review discusses androgenetic alopecia and alopecia areata through a systems biology lens, emphasizing the role of multi-omics data integration to explore molecular mechanisms and potential therapeutic strategies, but offers no new clinical results.

research Pulsed Administration of Corticosteroids in the Treatment of Alopecia Areata

117 citations , February 1996 in “International Journal of Dermatology”

This study found that monthly oral prednisolone pulses of 300 mg were effective and safe for treating widespread alopecia areata, with 58.3% of patients achieving cosmetically acceptable hair growth.

research PUVA Treatment of Alopecia Areata Partialis, Totalis, and Universalis: Audit of 10 Years' Experience at St John's Institute of Dermatology

105 citations , December 1995 in “British journal of dermatology/British journal of dermatology, Supplement”

This retrospective study concluded that PUVA treatment is generally ineffective for alopecia areata, with low effective success rates for partialis, totalis, and universalis types.

research Vitiligo Complicating Diphencyprone Sensitization Therapy for Alopecia Universalis

47 citations , September 1995 in “British Journal of Dermatology”

This review discusses the complication of vitiligo in patients undergoing diphencyprone sensitization therapy for alopecia universalis and reports no new clinical findings.

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

101 citations , November 1992 in “Archives of Dermatology”

In this study, tapering prednisone followed by 2% topical minoxidil helped limit hair loss in some patients with alopecia areata, with 30% to 47% showing over 25% hair regrowth initially.

research Alopecia Areata in Children: Response to Treatment with Diphencyprone

84 citations , August 1991 in “British Journal of Dermatology”

This study found that 67% of children treated with diphencyprone for alopecia areata or alopecia totalis regrew scalp hair, with 33% achieving complete regrowth.

research Juvenile Versus Maturity-Onset Alopecia Areata: A Comparative Retrospective Clinical Study

164 citations , November 1989 in “Clinical and Experimental Dermatology”

This retrospective study found that juvenile alopecia areata is more severe and has a worse prognosis than maturity-onset alopecia areata.

research Extensive Alopecia Areata: Results of Treatment with 3% Topical Minoxidil

36 citations , March 1989 in “Cleveland Clinic Journal of Medicine”

3% topical minoxidil effectively treats extensive alopecia areata.

research Evaluation of Anthralin in the Treatment of Alopecia Areata

109 citations , November 1987 in “Archives of dermatology”

In this study, 0.5%-1.0% anthralin cream led to a cosmetic response in 25% of patients with severe alopecia areata, despite common side effects like pruritus and erythema.

research Topical Minoxidil Solution (1% and 5%) in the Treatment of Alopecia Areata

101 citations , March 1987 in “Journal of The American Academy of Dermatology”

Minoxidil solution helps hair regrowth in alopecia areata, with 5% being more effective.

research Double-Blind, Placebo-Controlled Evaluation of Topical Minoxidil in Extensive Alopecia Areata

104 citations , March 1987 in “Journal of The American Academy of Dermatology”

Minoxidil helps hair growth in 63.6% of alopecia patients, with 27.3% having excellent results.

research Topical Photochemotherapy for Alopecia Areata

63 citations , April 1985 in “Journal of the American Academy of Dermatology”

This study observed that topical PUVA treatment led to excellent or good hair regrowth in 45.4% of patients with alopecia areata, though many experienced relapse after treatment stopped.

research Topical Minoxidil in the Treatment of Alopecia Areata

80 citations , October 1983 in “BMJ”

This study found that 1% topical minoxidil induced significant hair regrowth in patients with alopecia areata, though it was less effective for those with extensive hair loss such as alopecia totalis and universalis.

research A Comparison of Intralesional Triamcinolone Hexacetonide and Triamcinolone Acetonide in Alopecia Areata

75 citations , September 1971 in “British Journal of Dermatology”

This study found that both intralesional triamcinolone acetonide and triamcinolone hexacetonide promote continuous hair growth in alopecia areata, with effects lasting at least 9 months after a single injection.