Treatment of Alopecia Areata

Introduction to Treatment Options

The British Journal of Dermatology recommends intralesional corticosteroids as the first-line treatment for limited patchy hair loss, while contact immunotherapy is recommended for extensive patchy hair loss 1, 2

For patients with limited patchy hair loss, the British Journal of Dermatology suggests intralesional corticosteroids (triamcinolone acetonide 5-10 mg/mL) as the first-line treatment, with success rates of up to 62% reported with monthly injections 1, 3, 4
The British Journal of Dermatology recommends contact immunotherapy (diphenylcyclopropenone [DPCP]) as the first-line treatment for extensive patchy hair loss, stimulating cosmetically worthwhile hair regrowth in less than 50% of patients 1, 2

The British Journal of Dermatology notes that topical corticosteroids are widely prescribed but have limited evidence of efficacy, with very potent topical steroids (e.g., clobetasol propionate) being considered for some cases 1, 3
The British Journal of Dermatology advises against the routine use of systemic corticosteroids due to potential serious side effects and inadequate evidence of efficacy 1, 2

The British Journal of Dermatology suggests that no treatment is a legitimate option for many patients, especially those with limited disease of short duration (<1 year), as spontaneous remission occurs in up to 80% of patients with limited patchy hair loss 3, 5
The British Journal of Dermatology recommends monitoring for side effects such as skin atrophy, a consistent side effect of intralesional corticosteroids, particularly with triamcinolone 3, 4

Neither minoxidil nor spironolactone is considered first-line therapy for alopecia areata, according to the British Journal of Dermatology 6
Topical minoxidil has shown limited efficacy in alopecia areata, with studies showing variable response rates of 32-33%, as reported by the British Journal of Dermatology 6