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

A.G. Messenger; J. McKillop; P. Farrant; A.J. McDonagh; M. Sladden


The British Journal of Dermatology. 2012;166(5):916-926. 

In This Article

11.0 Summary

The details of evidence are given above. Alopecia areata is difficult to treat and few treatments have been assessed in RCTs. The tendency to spontaneous remission and the lack of adverse effects on general health are important considerations in management, and not treating is the best option in many cases. On the other hand, alopecia areata may cause considerable psychological and social disability and in some cases, particularly those seen in secondary care, it may be a chronic and persistent disease causing extensive or universal hair loss. In those cases where treatment is appropriate there is reasonable evidence to support the following (strength of recommendations are defined in Appendix 1 ):

Treatment with potent topical corticosteroids probably advances regrowth of hair in some patients with mild to moderate disease but there are no data on long-term outcomes.

Intralesional corticosteroids stimulate hair regrowth at the site of injection. The effect is temporary, lasting a few months, and it is unknown whether the long-term outcome is influenced.

Contact immunotherapy is the best-documented treatment in severe alopecia areata but it is not widely available, involves multiple visits to hospital over several months and stimulates cosmetically worthwhile hair regrowth in < 50% of patients. It is the only treatment likely to be effective in AT/AU, although the response rate is low. It may cause troublesome temporary local inflammation but serious side-effects are rare.

Dithranol (anthralin) and minoxidil lotion are widely prescribed by dermatologists for limited patchy alopecia areata, and are safe, but there is no convincing evidence that they are effective.

Continuous or pulsed systemic corticosteroids and PUVA have also been used to treat alopecia areata. However, in view of the potentially serious side-effects and inadequate evidence of efficacy, none can be recommended at this time.

Children may be treated in a similar fashion to adults. However, intralesional steroids are often poorly tolerated and many clinicians are reluctant to use aggressive treatments such as contact immunotherapy in children.


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