Italian Guidelines in Diagnosis and Treatment of Alopecia Areata

December 2019 in “ Giornale italiano di dermatologia e venereologia ”

Alfredo Rossi, Marta Mellai, Bianca Maria Piraccini, Michela Starace, Marta Carlesimo, Victor Desmond Mandel, Aurora Alessandrini, Stefano Calvieri, Gemma Caro, Andrea D’Arino, Alessandro Di Federico, Francesca Magri, Flavia Pigliacelli, Graziana Amendolagine, Marco Annunziata, Maria C Arisi, Stefano Astorino, Graziella Babino, Federico Bardazzi, Stefania Barruscotti, Anna Belloni Fortina, Alessandro Borghi, Francesca Bruni, Stefano Caccavale, Piergiacomo Calzavara‐Pinton, Norma Cameli, Michele Cardone, Andrea Carugno, Rosa Coppola, Annunziata Dattola, Maria Beatrice De Felici Del Giudice, Antonella Di Cesare, Emi Dika, Donato Di Nunno, Francesco Domenico D’Ovidio, Gabriella Fabbrocini, Claudio Feliciani, Elisabetta Fulgione, Marco Galluzzo, Simone Garcovich, Valentina Garelli, Cristina Guerriero, Katharina Hansel, M. La Plaça, Francesco Lacarrubba, Viviana Lora, Elena Marinello, Matteo Megna, Giuseppe Micali, Cosimo Misciali, Paola Monari, Giuseppe Monfrecola, Iria Neri, Annamaria Offidani, Gloria Orlando, Manuela Papini, Annalisa Patrizi, Stefano Piaserico, Niccolò Rivetti, Oriana Simonetti, Teodora R Stan, Luca Stingeni, Mark S. Talamonti, F. Tassone, Lucia Villa, Colombina Vincenzi, Maria Caterina Fortuna

alopecia areata autoimmune disorder hair follicles anagen phase clinical trials treatment recommendations AA

TLDR The Italian guidelines offer advice for diagnosing and treating alopecia areata based on expert opinion and limited clinical trial evidence.

The document from December 2019, "Italian Guidelines in diagnosis and treatment of alopecia areata," presented guidelines proposed by the Italian Study Group for Cutaneous Annexial Disease of the Italian Society of Dermatology for diagnosing and treating Alopecia Areata (AA). AA is an organ-specific autoimmune disorder that targets hair follicles in the anagen phase, with an unpredictable course and treatments of variable efficacy. At the time, there was little evidence from well-designed clinical trials on AA treatment, and none of the treatments or devices commonly used were specifically approved by the Food and Drug Administration. The guidelines aimed to provide evidence-based treatment recommendations combined with expert advice for the daily management of AA.

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research Ruxolitinib for the Treatment of Severe Alopecia Areata

37 citations , February 2019 in “Journal of the American Academy of Dermatology”

Ruxolitinib can help regrow hair in severe alopecia areata.

research Tofacitinib for the Treatment of Alopecia Areata in Preadolescent Children

40 citations , February 2019 in “Journal of the American Academy of Dermatology”

Tofacitinib helped some young children with severe hair loss grow their hair back without bad side effects.

research Treatment of Alopecia Universalis with Topical Janus Kinase Inhibitors – A Double Blind, Placebo, and Active Controlled Pilot Study

49 citations , August 2018 in “International Journal of Dermatology”

Topical JAK inhibitors may help treat alopecia universalis by promoting hair regrowth.

research An Open-Label Pilot Study to Evaluate the Efficacy of Tofacitinib in Moderate to Severe Patch-Type Alopecia Areata, Totalis, and Universalis

130 citations , July 2018 in “Journal of Investigative Dermatology”

Tofacitinib may help treat severe hair loss, but more research is needed.

research Topical 2% Tofacitinib for Children with Alopecia Areata, Alopecia Totalis, and Alopecia Universalis

49 citations , June 2018 in “Journal of the American Academy of Dermatology”

Applying 2% tofacitinib cream helped some children with severe hair loss grow back hair.

research Retrospective Analysis of the Application of Fumaric Acid Esters in 13 Patients with Alopecia Areata

4 citations , May 2018 in “European journal of dermatology/EJD. European journal of dermatology”

Fumaric acid esters might help treat alopecia areata, but more research is needed.

research Trichoscopy of Alopecia Areata: An Update

89 citations , March 2018 in “The Journal of Dermatology”

Trichoscopy helps diagnose and monitor alopecia areata by looking at a combination of specific hair and scalp features.

research Tofacitinib 2% Ointment, a Topical Janus Kinase Inhibitor, for the Treatment of Alopecia Areata: A Pilot Study of 10 Patients

48 citations , February 2018 in “Journal of the American Academy of Dermatology”

Tofacitinib 2% ointment helped hair regrow in 3 out of 10 patients with alopecia areata, but caused side effects like scalp irritation and raised cholesterol in some.

research Alopecia Areata: Treatment Options and Efficacy

182 citations , January 2018 in “Journal of the American Academy of Dermatology”

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.

research A Review of Monochromatic Light Devices for the Treatment of Alopecia Areata

28 citations , December 2017 in “Lasers in Medical Science”

Monochromatic light devices, especially the 308-nm excimer laser, are promising for treating alopecia areata but more research is needed.

research Topical Janus Kinase Inhibitors for the Treatment of Pediatric Alopecia Areata

83 citations , July 2017 in “Journal of the American Academy of Dermatology”

Topical JAK inhibitors may help children with alopecia areata regrow hair.

research Treatment of Alopecia Areata With Tofacitinib

78 citations , June 2017 in “JAMA Dermatology”

Tofacitinib helped regrow hair in people with severe alopecia, but side effects occurred and benefits stopped after treatment ended.

research Experience with Oral Tofacitinib in 8 Adolescent Patients with Alopecia Universalis

49 citations , April 2017 in “Journal of the American Academy of Dermatology”

Tofacitinib caused significant hair regrowth in adolescents with alopecia universalis who didn't respond to other treatments.

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

139 citations , January 2017 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 , January 2017 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 Simvastatin/Ezetimibe Therapy for Recalcitrant Alopecia Areata: An Open Prospective Study of 14 Patients

13 citations , January 2017 in “Annals of dermatology/Annals of Dermatology”

Simvastatin/ezetimibe may help some patients with severe alopecia areata regrow hair.

research Unsuccessful Treatment of Alopecia Areata with Simvastatin/Ezetimibe: Experience in 12 Patients

14 citations , January 2017 in “Skin appendage disorders”

Simvastatin/ezetimibe did not effectively treat severe alopecia areata and caused side effects in some patients.

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 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 Reflectance Confocal Microscopy for Scarring and Non-Scarring Alopecia Real-Time Assessment

17 citations , May 2016 in “Archives of Dermatological Research”

Reflectance confocal microscopy can help tell apart scarring from non-scarring hair loss.

research Tofacitinib Citrate for the Treatment of Nail Dystrophy Associated with Alopecia Universalis

41 citations , April 2016 in “JAMA Dermatology”

Tofacitinib citrate improved nail dystrophy and pain in patients with alopecia universalis without causing side effects.

research Topical Ruxolitinib for the Treatment of Alopecia Universalis

96 citations , April 2016 in “JAMA dermatology”

research Rapid Skin Repigmentation on Oral Ruxolitinib in a Patient with Coexistent Vitiligo and Alopecia Areata

157 citations , February 2016 in “Journal of the American Academy of Dermatology”

A man with vitiligo and alopecia saw quick skin and hair improvement with ruxolitinib, but skin color gains were lost after stopping treatment.

research A Comparative Study of Oral Cyclosporine and Betamethasone Minipulse Therapy in the Treatment of Alopecia Areata

14 citations , January 2016 in “Annals of dermatology/Annals of Dermatology”

Oral cyclosporine is more effective and safer than betamethasone for treating alopecia areata.

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 , April 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 Comparison of High-Dose Corticosteroid Pulse Therapy and Combination Therapy Using Oral Cyclosporine with Low-Dose Corticosteroid in Severe Alopecia Areata

14 citations , January 2015 in “Annals of dermatology/Annals of Dermatology”

Corticosteroid pulse therapy is more effective for severe alopecia areata than combination therapy.

research Scalp Dermoscopy or Trichoscopy

69 citations , January 2015 in “Current problems in dermatology”

Trichoscopy is a quick, noninvasive method to diagnose hair and scalp disorders, often reducing the need for biopsies.

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

185 citations , December 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.

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 Alopecia Areata: An Evidence-Based Treatment Update

72 citations , July 2014 in “American journal of clinical dermatology”

Some treatments, like corticosteroids and sensitizing agents, can help with alopecia areata, but more high-quality research is needed.

research Clobetasol Propionate, 0.05%, vs Hydrocortisone, 1%, for Alopecia Areata in Children

49 citations , January 2014 in “JAMA dermatology”

Clobetasol propionate, 0.05%, is more effective and safe for treating childhood alopecia areata than hydrocortisone, 1%.

research Overview of Alopecia Areata

110 citations , December 2013 in “The journal of investigative dermatology. Symposium proceedings/The Journal of investigative dermatology symposium proceedings”

Alopecia areata is a genetic and immune-related hair loss condition that is often associated with other autoimmune diseases and does not typically cause permanent damage to hair follicles.

research The Effect of Oral Cyclosporine in the Treatment of Severe Alopecia Areata

33 citations , October 2013 in “Cutaneous and ocular toxicology”

Oral cyclosporine can help regrow hair in severe alopecia areata cases.

research A Randomized, Double-Blind, Placebo- and Active-Controlled, Half-Head Study to Evaluate the Effects of Platelet-Rich Plasma on Alopecia Areata

205 citations , August 2013 in “British Journal of Dermatology”

Platelet-rich plasma treatment significantly increased hair regrowth and decreased discomfort in alopecia patients, making it a potentially better and safer treatment option.

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

218 citations , May 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 Histopathology of Alopecia Areata, Acute and Chronic: Why Is It Important to the Clinician?

43 citations , May 2011 in “Dermatologic Therapy”

Recognizing the different stages of alopecia areata is crucial for accurate diagnosis and treatment.

research Reflectance Confocal Microscopy of the Yellow Dot Pattern in Alopecia Areata

39 citations , January 2011 in “Archives of Dermatology”

Reflectance confocal microscopy confirms that yellow dots are signs of damaged hair follicles in alopecia areata.

research Randomized Comparison of Topical Betamethasone Valerate Foam, Intralesional Triamcinolone Acetonide, and Tacrolimus Ointment in Management of Localized Alopecia Areata

48 citations , January 2011 in “International journal of trichology”

Intralesional triamcinolone acetonide is the most effective treatment for localized alopecia areata.

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

50 citations , April 2010 in “Journal of The European Academy of Dermatology and Venereology”

Latanoprost can effectively treat eyelash hair loss, with 45% of patients showing hair regrowth and no reported side effects.

research Alopecia Areata Update

244 citations , February 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.

research The Efficacy of Latanoprost in the Treatment of Alopecia Areata of Eyelashes and Eyebrows

20 citations , November 2009 in “European Journal of Dermatology”

Latanoprost, a glaucoma treatment, was found ineffective in treating hair loss in eyebrows and eyelashes.

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

43 citations , November 2009 in “Archives of dermatology”

Alefacept does not effectively treat severe alopecia areata.

research Phase I/II Randomized Bilateral Half-Head Comparison of Topical Bexarotene 1% Gel for Alopecia Areata

44 citations , October 2009 in “Journal of the American Academy of Dermatology”

Topical bexarotene 1% gel might help regrow hair in alopecia areata and is generally safe.

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

79 citations , September 2009 in “Pediatric dermatology”

The 308-nm Excimer laser is effective and safe for treating patchy alopecia areata in children.

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

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

Topical latanoprost and bimatoprost eye solutions don't help eyelash growth in people with alopecia areata.

research In Vivo Reflectance Confocal Microscopy: Usefulness for Diagnosing Hair Diseases

25 citations , December 2008 in “Journal of Dermatological Case Reports”

In vivo reflectance confocal microscopy is useful for evaluating hair shaft diseases but needs improvement for deeper hair follicle issues.

research Treatment of Persistent Alopecia Areata with Sulfasalazine

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

Sulfasalazine may help treat persistent alopecia areata.

research Clinical Significance of Dermoscopy in Alopecia Areata: Analysis of 300 Cases

196 citations , June 2008 in “International Journal of Dermatology”

Dermoscopy helps diagnose and manage alopecia areata by showing specific hair changes.

research Lack of Response of Alopecia Areata to Pimecrolimus Cream

26 citations , July 2007 in “Clinical and experimental dermatology”

Pimecrolimus cream is not effective for treating alopecia areata.

research Development of Alopecia Areata Universalis in a Patient Receiving Adalimumab

69 citations , December 2006 in “Archives of dermatology”

Adalimumab may cause severe hair loss in some patients.

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”

The pulsed infrared diode laser is effective for treating hair loss in alopecia areata.

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”

Clobetasol propionate ointment can help some people with total hair loss regrow hair.

research Optimal Management of Hair Loss (Alopecia) in Children

49 citations , January 2003 in “American Journal of Clinical Dermatology”

Effective management of children's hair loss involves accurate diagnosis, various treatments, and supportive care.

research Sulfasalazine for alopecia areata

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

Sulfasalazine may help regrow hair in severe alopecia areata cases.

research Randomized Trial of Aromatherapy

122 citations , November 1998 in “Archives of Dermatology”

Aromatherapy with certain essential oils is a safe and effective treatment for hair growth in alopecia areata patients.

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.

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”

Anthralin cream helped 25% of patients with severe alopecia areata regrow hair, but caused skin irritation.

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 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 Topical photochemotherapy for alopecia areata

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

Topical PUVA can cause temporary hair regrowth in some alopecia areata patients but doesn't change the long-term outcome.

research Topical Minoxidil in the Treatment of Alopecia Areata

80 citations , October 1983 in “BMJ”

Minoxidil helps hair regrowth in alopecia patients, with 16 having good results and no side effects.

research Large doses of glucocorticoid in the treatment of alopecia areata

80 citations , November 1975 in “Acta dermato-venereologica”

Large doses of glucocorticoids are not suitable for general use in treating severe alopecia areata due to inconsistent results and risks.

3 / 3 results

research Alopecia Areata: A Multifactorial Autoimmune Condition

148 citations , March 2019 in “Journal of autoimmunity”

Alopecia areata is an autoimmune disease causing patchy hair loss, often with other autoimmune disorders, but its exact causes are unknown.

research Treating Resistant Cases of Alopecia Universalis

May 2018 in “Journal of cosmetology & trichology”

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research Effectivity of Minoxidil as a Treatment for Alopecia Areata

January 2014 in “DOAJ (DOAJ: Directory of Open Access Journals)”