Systemic Therapies for Pediatric Alopecia Areata

Alopecia areata (AA) in children often requires systemic treatment when the condition is extensive. This review highlights the limited high-quality evidence available for systemic therapies in pediatric AA, with most data derived from case reports and series. Janus kinase inhibitors are the only medications with systematic data supporting their use. Oral minoxidil shows promise, particularly as an adjunctive treatment, while dupilumab may benefit patients with AA and comorbid atopy. Systemic corticosteroids can offer initial improvement but are not suitable for long-term use due to adverse effects and loss of efficacy upon discontinuation. Traditional immunomodulatory drugs like methotrexate, cyclosporine, and azathioprine have minimal supporting literature for their use in pediatric AA.