Most Adults With Alopecia Areata Untreated 1 Year After Diagnosis

Heidi Splete

September 20, 2023


Nearly three-quarters of adults with alopecia areata (AA) were not receiving treatment 1 year after diagnosis, according to a retrospective cohort study using data from more than 45,000 individuals.


  • The study population included 45,483 adults aged 18 years and older with new diagnoses of AA between October 15, 2015, and February 28, 2020. Data were from a large US healthcare database that included medical and pharmacy claims.

  • The mean age of the participants was 43.8 years, 65.7% were female.

  • The researchers measured variables that might relate to AA and its treatment patterns within 1 year of starting the study and during the first year of the study, with data collected at 1, 42, 84, and 365 days after study entry.


  • During the first year after diagnosis, 66.4% of patients received at least one treatment for AA at one or more time points.

  • At 1 year, 71.8% of patients were not receiving any active treatment for AA.

  • Among those who received treatment, intralesional injections were the most often prescribed therapy (41.8% of patients), followed by topical corticosteroids (40.9%), intramuscular corticosteroids (38.1%), and oral corticosteroids (20.6%).

  • Patients diagnosed with either alopecia totalis or alopecia universalis were significantly less likely to receive intralesional steroids and significantly more likely to receive topical corticosteroids than those without these diagnoses (11.1% vs 44.1% and 25.4% vs 42.1, respectively).


The results highlight the need to determine why so many alopecia patients with AA were no longer on treatment after 1 year, although treatment trends may change with the emergence of new therapies, such as JAK inhibitors and others, according to the authors.


The lead author of the study was Hemin Lee, MD, MPH, Brigham and Women’s Hospital, Boston, Massachusetts. The study was published online in JAMA Dermatology September 20, 2023.


The use of insurance claims data did not allow analysis of over-the-counter medications and treatments, and the lack of a single ICD-10 code for defining AA could have resulted in misclassification of outcomes.


The study received no outside funding, and Lee had no disclosures; one author had disclosures that included receiving personal fees from Pfizer and Concert outside of the submitted study and participating in alopecia-related trials with Lilly, Concert, Aclaris, and Incyte. Another author's disclosures included receiving personal fees from companies that included Pfizer, Concert, Lilly, and AbbVie. No other disclosures were reported.

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