Treating Alopecia Areata: Current Practices Versus New Directions

Aditya K. Gupta; Jessie Carviel; William Abramovits


Am J Clin Dermatol. 2017;18(1):67-75. 

In This Article

Abstract and Introduction


Alopecia areata (AA) is non-scarring hair loss resulting from an autoimmune disorder. Severity varies from patchy hair loss that often spontaneously resolves to severe and chronic cases that can progress to total loss of scalp and body hair. Many treatments are available; however, the efficacy of these treatments has not been confirmed, especially in severe cases, and relapse rates are high. First-line treatment often includes corticosteroids such as intralesional or topical steroids for mild cases and systemic steroids or topical immunotherapy with diphenylcyclopropenone or squaric acid dibutylester in severe cases. Minoxidil and bimatoprost may also be recommended, usually in combination with another treatment. Ongoing research and new insights into mechanisms have led to proposals of innovative therapies. New directions include biologics targeting immune response as well as lasers and autologous platelet-rich plasma therapy. Preliminary data are encouraging, and it is hoped this research will translate into new options for the treatment of AA in the near future.


Alopecia areata (AA) is an autoimmune disease that results in non-scarring hair loss mediated through chronic hair follicle inflammation.[1,2] Hair loss can be mild and self-limited in some cases or progress to increasingly severe with the loss of all scalp hair (alopecia totalis [AT]) and body hair (alopecia universalis [AU]).

Many approaches have traditionally been used for the treatment of AA; however, none have been approved by the US FDA. Efficacy evidence has come from individual experience, observational studies, and trials with major limitations, leading to high failure rates and frequent relapses.[3,4] None of these therapies have been validated in randomized controlled trials.[5] Furthermore, as spontaneous remission rates are high, especially in mild AA of under a year, there have been suggestions that treatment is unnecessary.[6] The prognosis for severe or long-standing AA is not as optimistic, and next-generation treatment options are still required. Here, we compare traditional treatments with new and emerging techniques.