An Update in the Management of Alopecia Areata

July 2023 in “ IntechOpen eBooks ”

Alberto Soto‐Moreno, Clara Ureña-Paniego, Trinidad Montero‐Vílchez, Salvador Arias‐Santiago

Alopecia Areata non-scarring alopecia anagen catagen telogen topical minoxidil oral minoxidil corticosteroids Janus kinase inhibitors platelet-rich plasma triamcinolone acetonide Apremilast Dupilumab Abatacept AA Rogaine PRP

From the encyclopedia

Alopecia Areata →

autoimmune disorder causing patchy hair loss

Platelet-Rich Plasma →

growth factors taken from your blood and injected into your scalp to stimulate hair

Triamcinolone Acetonide →

Studysummary This review highlights that alopecia areata, a common type of hair loss, currently lacks preventive or curative treatments, and traditional therapies such as minoxidil and corticosteroids offer inconsistent results, necessitating patient-consensual treatment planning. Our plain-language summary of this paper — not a Tressless recommendation.

Alopecia Areata (AA) is a common type of non-scarring alopecia with no current preventive or curative treatment. It is caused by an aberrant immune response leading to premature transition of hair follicles from anagen to catagen and telogen phase. Treatments include topical and oral minoxidil, corticosteroids, and newer therapies like Janus kinase inhibitors. A study with 45 participants showed platelet-rich plasma was superior to triamcinolone acetonide in inducing hair growth, while another study with 19,218 patients showed that oral administration of low-dose minoxidil improved 18 to 82.4% of patients. However, further large-scale studies are needed to evaluate the efficacy of these treatments. Other treatments like Apremilast, Dupilumab, and Abatacept have varying degrees of efficacy. The document emphasizes the importance of shared decision-making between patients and healthcare providers in choosing the most suitable treatment option.

View this study on intechopen.com →

Discuss this study in the Community →

Research cited in this study

63 / 63 results

research Trichoscopy in Alopecia Areata

7 citations , November 2022 in “Actas Dermo-Sifiliográficas”

This study reviewed the usefulness of trichoscopy in diagnosing and monitoring alopecia areata, noting that the technique identifies specific hair features like yellow and black dots, which are linked to the disease's chronic nature and treatment response.

research Shared Decision-Making, Therapeutic Choice, and Decisional Regret in Patients With Alopecia Areata

23 citations , August 2022 in “JAMA Dermatology”

In this study, patients with alopecia areata indicated a preference for shared decision-making (SDM) with their dermatologists, and those who engaged in SDM reported less decisional regret about their treatment choices.

research Photobiomodulation Therapy With Different Wavebands for Hair Loss: A Systematic Review and Meta-Analysis

3 citations , April 2022 in “Dermatologic Surgery”

This systematic review found that photobiomodulation therapies using ultraviolet and infrared light effectively treated alopecia areata, while red and infrared light treatments were effective for androgenetic alopecia.

research Two Phase 3 Trials of Baricitinib for Alopecia Areata

148 citations , March 2022 in “The New England Journal of Medicine”

In two phase 3 trials, this study found that oral baricitinib significantly improved hair regrowth compared to placebo in adults with severe alopecia areata after 36 weeks, though longer trials are needed to ascertain its long-term efficacy and safety.

research Alopecia Areata and Dexamethasone Mini-Pulse Therapy: A Prospective Cohort Study on Real World Evidence and Factors Related to Successful Response

16 citations , March 2022 in “Journal of Clinical Medicine”

In this observational study, researchers found that mini-pulse oral corticosteroids effectively reduced hair loss in alopecia areata patients who did not respond to topical therapies, though early-onset patients and those with hypothyroidism were less likely to benefit.

research A Systematic Review on the Treatment of Pediatric Severe Alopecia Areata by Topical Immunotherapy, Anthralin, or Low-Level Light/Laser Therapy: Focus on Efficacy, Safety, Treatment Duration, Recurrence, and Follow-Up Based on Clinical Studies

17 citations , October 2021 in “Journal of Cosmetic Dermatology”

This review found that topical immunotherapy and light/laser therapy may achieve over 50% hair regrowth efficacy in treating extensive alopecia areata in children, with no serious side effects observed.

research Alopecia Areata: An Update on Etiopathogenesis, Diagnosis, and Management

290 citations , August 2021 in “Clinical Reviews in Allergy & Immunology”

JAK inhibitors show promise for treating alopecia areata, but more research is needed.

research The Epidemiology of Alopecia Areata: A Population-Based Cohort Study in UK Primary Care

117 citations , July 2021 in “British Journal of Dermatology”

This study reports that the incidence of alopecia areata is 0.26 per 1000 person-years in the UK, with higher rates among Asian ethnic groups, socially deprived populations, and urban residents.

research A Phase 2a Randomized, Placebo-Controlled Study to Evaluate the Efficacy and Safety of the Oral Janus Kinase Inhibitors Ritlecitinib and Brepocitinib in Alopecia Areata: 24-Week Results

138 citations , March 2021 in “Journal of the American Academy of Dermatology”

This study found that treatment with ritlecitinib or brepocitinib was effective in improving scalp hair loss for patients with alopecia areata over 24 weeks compared to placebo.

research New Onset of Alopecia Areata in a Patient with SARS-CoV-2 Infection: Possible Pathogenetic Correlations

32 citations , March 2021 in “Journal of cosmetic dermatology (Print)”

This letter to the editor discusses a potential link between new onset alopecia areata and SARS-CoV-2 infection, but reports no new clinical results.

research Development and Validation of the Brigham Eyelash Tool for Alopecia: A Measure of Eyelash Alopecia Areata

6 citations , March 2021 in “Journal of the American Academy of Dermatology”

This study found that the Brigham Eyelash Tool for Alopecia (BELA) is a reliable measure for assessing eyelash loss in alopecia areata patients, demonstrating high inter- and intrarater reliability.

Usefulness of High-Frequency Ultrasonography in the Assessment of Alopecia Areata – Comparison of Ultrasound Images with Trichoscopic Images

research Usefulness of High-Frequency Ultrasonography in the Assessment of Alopecia Areata – Comparison of Ultrasound Images with Trichoscopic Images

4 citations , March 2021 in “Postepy Dermatologii I Alergologii”

This study found that high-frequency ultrasonography may effectively distinguish different stages of alopecia areata and differentiate it from other scalp conditions.

research Application of Topical Immunotherapy in the Treatment of Alopecia Areata: A Review and Update

20 citations , March 2021 in “Drug design, development and therapy”

This review summarizes the pharmacology, mechanisms, and clinical efficacy of topical immunotherapy for alopecia areata but reports no new clinical results.

research Treatments for Alopecia Areata: A Systematic Review and Network Meta-Analysis

23 citations , February 2021 in “Dermatologic therapy”

This study found that pentoxifylline plus topical corticosteroids had the highest treatment success rate for alopecia areata compared to no treatment, but the best overall treatment remains uncertain due to varying data.

research Alopecia Areata: A Review on Diagnosis, Immunological Etiopathogenesis, and Treatment Options

56 citations , January 2021 in “Clinical and Experimental Medicine”

This review highlights the challenges in treating alopecia areata, noting that current therapies often lead to relapse and have uncertain long-term effectiveness; it also points to potential future treatments such as JAK-STAT inhibitors and PRP.

research Brigham Eyebrow Tool for Alopecia: A Reliable Assessment of Eyebrow Alopecia Areata

4 citations , November 2020 in “Journal of Investigative Dermatology Symposium Proceedings”

The Brigham Eyebrow Tool for Alopecia is a simple and reliable way to measure eyebrow hair loss.

research Platelet-Rich Plasma in the Treatment of Alopecia Areata: A Review

15 citations , October 2020 in “Journal of Investigative Dermatology Symposium Proceedings”

This review discusses the potential use of platelet-rich plasma for treating alopecia areata but reports no new experimental findings, noting the need for standardized protocols and larger studies to evaluate its efficacy.

research Alopecia Areata Susceptibility Variant in MHC Region Impacts Expressions of Genes Contributing to Hair Keratinization and Is Involved in Hair Loss

19 citations , July 2020 in “EBioMedicine”

In this study, the researchers identified a variant in the CCHCR1 gene associated with an alopecia areata subtype characterized by impaired keratinization and autoimmune events.

research Low-Dose Oral Minoxidil as Treatment for Non-Scarring Alopecia: A Systematic Review

19 citations , June 2020 in “International Journal of Dermatology”

In this systematic review, oral minoxidil was found to be a safe and effective treatment for androgenetic alopecia and alopecia areata, with additional benefits for female pattern hair loss and other types of alopecia, although common side effects included hypertrichosis and postural hypotension.

research New and Emerging Therapies for Alopecia Areata

46 citations , April 2020 in “Drugs”

Emerging therapies like JAK inhibitors show promise for hair regrowth in alopecia areata.

research Functional Complexity of Hair Follicle Stem Cell Niche and Therapeutic Targeting of Niche Dysfunction for Hair Regeneration

59 citations , March 2020 in “Journal of Biomedical Science”

This study explored the complex roles of niche cells in regulating hair follicle stem cells, identifying specific cell functions such as signaling, sensing, and relaying messages, which could provide insights into treating hair loss conditions like androgenetic alopecia and alopecia areata.

Alopecia Areata Incognita and Diffuse Alopecia Areata: Clinical, Trichoscopic, Histopathological, and Therapeutic Features of a 5-Year Study

research Alopecia Areata Incognita and Diffuse Alopecia Areata: Clinical, Trichoscopic, Histopathological, and Therapeutic Features of a 5-Year Study

23 citations , September 2019 in “Dermatology practical & conceptual”

This study analyzed the features of alopecia areata incognita and diffuse alopecia areata, finding distinct patterns in hair loss regions and trichoscopic signs, and noted a benign course responsive to topical steroid therapy.

research Alopecia Areata in 2 Patients Treated with Dupilumab: New Onset and Worsening

26 citations , July 2019 in “JAAD Case Reports”

This study reports two cases of hair loss outcomes in patients using dupilumab for atopic dermatitis, with one showing improvement in alopecia universalis and another experiencing worsening of alopecia totalis.

research Cyclosporine for Moderate-to-Severe Alopecia Areata: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial of Efficacy and Safety

44 citations , April 2019 in “Journal of the American Academy of Dermatology”

This study observed that cyclosporine showed a trend toward improving alopecia areata symptoms compared to placebo, but the difference was not statistically significant.

research Minoxidil for Patchy Alopecia Areata: Systematic Review and Meta-Analysis

20 citations , March 2019 in “Journal of The European Academy of Dermatology and Venereology”

In this study, 5% minoxidil significantly improved outcomes for children and adults with patchy alopecia areata compared to placebo, with moderate quality evidence and no severe adverse events reported, though more research is needed to address remaining uncertainties.

A Randomized Placebo-Controlled Single-Center Pilot Study of the Safety and Efficacy of Apremilast in Subjects with Moderate-to-Severe Alopecia Areata

research A Randomized Placebo-Controlled Single-Center Pilot Study of the Safety and Efficacy of Apremilast in Subjects with Moderate-to-Severe Alopecia Areata

42 citations , November 2018 in “Archives of dermatological research”

Apremilast was not effective in treating moderate-to-severe alopecia areata.

research Treatment of Alopecia Areata: An Australian Expert Consensus Statement

95 citations , November 2018 in “Australasian journal of dermatology”

This consensus statement outlines a treatment algorithm for alopecia areata, discussing when to consider systemic treatment and how to assess outcomes, without providing new clinical results.

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”

In this phase I study, partial hair regrowth was observed in patients with alopecia universalis using topical JAK inhibitors, though more research is needed to confirm potential as a treatment alternative to clobetasol.

research Alopecia Areata: A Review of Disease Pathogenesis

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

This study reviewed recent theories on alopecia areata's pathogenesis, highlighting its autoimmune nature due to immune privilege disruption in hair follicles, and noted current treatments have limited efficacy with high relapse rates, underscoring the need for further research into its mechanisms for better therapies.

research Trichoscopy of Alopecia Areata: An Update

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

This review presents various trichoscopic findings for diagnosing alopecia areata but reports no new clinical results, emphasizing that no single marker is pathognomonic and multiple features should be considered together.

research Hair Follicle Immune Privilege Revisited: The Key to Alopecia Areata Management

102 citations , December 2017 in “The journal of investigative dermatology. Symposium proceedings/The Journal of investigative dermatology symposium proceedings”

This review discusses the role of immune privilege collapse in the pathogenesis of alopecia areata, emphasizing the potential for therapeutic manipulation of hair bulb immune privilege to offer new treatment options, and reports no new results.

research Alopecia Areata: Overview and Insights from January 2018

290 citations , December 2017 in “Journal of The American Academy of Dermatology”

This article reviews the epidemiology, clinical evaluation, and pathogenesis of alopecia areata and highlights recent advancements, but it does not report new clinical findings.

Systematic Review and Quality Analysis of Studies on the Efficacy of Topical Diphenylcyclopropenone Treatment for Alopecia Areata

research Systematic Review and Quality Analysis of Studies on the Efficacy of Topical Diphenylcyclopropenone Treatment for Alopecia Areata

21 citations , June 2017 in “Journal of The American Academy of Dermatology”

This study reviewed existing articles to assess the efficacy of topical diphenylcyclopropenone immunotherapy for alopecia areata, but it did not report new clinical results.

research Factors Associated With Severity Of Alopecia Areata

63 citations , January 2017 in “Annals of Dermatology”

More research is needed to understand alopecia areata severity.

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 A Review on Laser and Light-Based Therapies for Alopecia Areata

16 citations , November 2016 in “Journal of Cosmetic and Laser Therapy”

This review highlights that laser and light treatments could serve as safe and effective alternatives to current therapies for alopecia areata, with the excimer laser showing positive results, though further randomized controlled trials are necessary to establish optimal treatment protocols.

research Platelet-Rich Plasma Versus Minoxidil 5% in Treatment of Alopecia Areata: A Trichoscopic Evaluation

62 citations , October 2016 in “Dermatologic Therapy”

This study found that platelet-rich plasma was more effective for treating alopecia areata than topical 5% minoxidil, leading to earlier hair regrowth and reduction in hair abnormalities.

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 Familial Aggregation of Alopecia Areata

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

This review examines the immunological aspects of alopecia areata, focusing on genetic, neuroimmunological, and immune privilege factors, but does not report new clinical findings.

research 308-Nanometer Excimer Light Therapy for Alopecia Universalis Resistant to Other Treatments: A Clinical Study of 11 Patients

13 citations , April 2016 in “Journal of Dermatology”

In this study, 308-nm excimer light therapy showed significant effects in some patients with treatment-resistant alopecia universalis, suggesting it as a potential alternative therapy.

research A Systematic Review of Pulse Steroid Therapy for Alopecia Areata

50 citations , January 2016 in “Journal of the American Academy of Dermatology”

This systematic review of pulse corticosteroid therapy for alopecia areata found relatively low complete response rates, but responders experienced low relapse rates, indicating potential benefits for patients with favorable prognostic factors.

research Extensive Alopecia Areata Is Reversed by IL-12/IL-23p40 Cytokine Antagonism

68 citations , November 2015 in “The Journal of Allergy and Clinical Immunology”

In this study, three patients with extensive alopecia areata showed varying degrees of hair regrowth after 20 weeks of treatment with ustekinumab, a cytokine-targeting therapy.

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

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

This article discusses the autoimmune pathogenesis of alopecia areata and reviews the use of immunosuppressive therapies in its treatment, but it does not provide new clinical results.

research Trichoscopic Findings in Alopecia Areata and Their Relation to Disease Activity, Severity, and Clinical Subtype in Turkish Patients

26 citations , August 2013 in “Australasian Journal of Dermatology”

This study found that certain trichoscopic patterns, like exclamation mark hairs, were associated with active or mild alopecia areata in Turkish patients, aiding in diagnosis and prediction of the disease.

research Syphilitic Alopecia: A Report of 5 Cases and a Review of the Literature

13 citations , June 2013 in “Actas Dermo-Sifiliográficas”

This review details five cases of syphilitic alopecia, an uncommon symptom in syphilis affecting mainly men, emphasizing that dermatologists should be vigilant as it can appear as the sole symptom.

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

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 , April 2013 in “British Journal of Dermatology”

In this study, platelet-rich plasma significantly increased hair regrowth and reduced symptoms of alopecia areata compared to triamcinolone acetonide or placebo, with no observed side effects.

research Somatostatin Expression in Human Hair Follicles and Its Potential Role in Immune Privilege

27 citations , January 2013 in “The journal of investigative dermatology/Journal of investigative dermatology”

This study identified somatostatin as a potential secretory factor contributing to the immune privilege of human hair follicles.

research Wigs and Hairpieces: Evaluating Dermatologic Issues

22 citations , May 2012 in “Dermatologic Therapy”

This article reviews the lack of major breakthroughs and limited therapeutic options for extensive hair loss, emphasizing the need to address its psychological impact; it reports no new clinical results.

research Calcitonin Gene-Related Peptide (CGRP) May Award Relative Protection from Interferon-γ-Induced Collapse of Human Hair Follicle Immune Privilege

47 citations , December 2011 in “Experimental Dermatology”

This study suggests that the neuropeptide CGRP may protect against, but not restore, IFNγ-induced collapse of hair follicle immune privilege in alopecia areata.

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

43 citations , May 2011 in “Dermatologic Therapy”

This article discusses the phases and histological features of alopecia areata and reports no new clinical findings; the authors emphasize recognizing these phases for accurate diagnosis.

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 Update

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

This article reviews the clinical presentation and histopathologic features of alopecia areata and proposes a hypothesis for its development, but it reports no new clinical results.

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

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

This study found that dermoscopic indicators like black dots and tapering hairs are valuable markers for diagnosing and assessing the severity and activity of alopecia areata in Asian patients.

research The Role of Scalp Dermoscopy in the Diagnosis of Alopecia Areata Incognita

150 citations , April 2008 in “Journal of The American Academy of Dermatology”

This study found that videodermoscopy reveals distinct dermoscopic features in patients with alopecia areata incognita, aiding in biopsy decisions by identifying the appropriate sampling area and potentially avoiding unnecessary procedures.

research Maintenance of Hair Follicle Immune Privilege Is Linked to Prevention of NK Cell Attack

253 citations , December 2007 in “Journal of Investigative Dermatology”

This study suggests that human hair follicles may actively suppress natural killer cells, which contrasts with the observed defects in NK cell regulation in alopecia areata.

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

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

In this study, researchers found that substance P triggered premature catagen development and immune changes in human scalp hair follicles, providing a possible biological link between stress and hair loss conditions like telogen effluvium and alopecia areata.

research Guidelines for the Management of Alopecia Areata

182 citations , October 2003 in “British Journal of Dermatology”

These guidelines for alopecia areata management, prepared by the British Association of Dermatologists, provide evidence-based treatment recommendations and insights into the condition's epidemiology, diagnosis, and investigation.

research Approach to the Adult Female Patient with Diffuse Nonscarring Alopecia

67 citations , November 2002 in “Journal of The American Academy of Dermatology”

This review discusses diagnostic approaches for women with diffuse, nonscarring hair loss and reports no new clinical results.

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 Alopecia Areata: Diagnosis and Management

48 citations , May 1999 in “International Journal of Dermatology”

This article reviews the diagnosis and management of alopecia areata but reports no new research findings.

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.