Fast Five Quiz: Hair Loss (Alopecia)

William James, MD


August 01, 2022

Treatment is not mandatory because the condition is benign, and spontaneous remissions and recurrences are common. Treatment modalities are usually considered first according to the extent of hair loss and the patient's age. Assessment of the efficacy of a treatment must be considered with care because the condition is highly unpredictable in presentation, evolution, and response to treatment. The US Food and Drug Administration recently approved the use of baricitinib oral tables for the systemic treatment of adult patients with severe alopecia areata. It is a Janus kinase (JAK) inhibitor that blocks the activity of one or more enzymes, interfering with the pathway that leads to inflammation.

Currently, intralesional corticosteroid injections are widely used in the treatment of alopecia areata. They are the first-line treatment in localized conditions and are usually superior to topical corticosteroids. Hair growth may persist for 6-9 months after a single injection. Injections are administered subcutaneously or intradermally using a 3-mL syringe and a 30-gauge needle. Topical steroids can be useful, especially in children who cannot tolerate injections.

Topical immunotherapy is defined as the induction and periodic elicitation of an allergic contact dermatitis by topical application of potent contact allergens. Commonly used agents for immunotherapy in alopecia areata include squaric acid dibutylester (SADBE) and diphencyprone (DPCP). Initial regrowth may be seen at weeks 12-24. Once cosmetically acceptable regrowth is achieved, the treatment can be tapered gradually. Almost all patients relapse if the treatment is discontinued, and maintenance treatment is needed.

Both systemic and topical psoralen plus UV-A (PUVA) therapies have been used in alopecia areata. Although PUVA is a relatively safe treatment modality, it is generally not an effective long-term treatment for alopecia areata.

Learn more about alopecia areata treatment.


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