dermatologic disorders
Alopecia Areata
Treatment of Alopecia Areata
Corticosteroids Sometimes topicalanthralin,minoxidil, or both Sometimes topical immunotherapy Sometimesmethotrexateorbaricitinib Rarely photochemotherapy or psoralen plus ultraviolet A (PUVA) Use of hairpieces and camouflage techniques If therapy is considered, intralesional corticosteroid injection is the treatment of choice in adults.Triamcinoloneacetonide suspension (typically in doses of 0.1 to 3 mL of 2.5 to 5 mg/mL concentration every 4 to 8 weeks) can be injected intradermally if the lesions are small. Potent topical corticosteroids (eg,clobetasolpropionate 0.05% foam, gel, or ointment 2 times a day for about 4 weeks) can be used; however, they often do not penetrate to the depth of the hair bulb where the inflammatory process is located. Oral corticosteroids are effective, but hair loss often recurs after cessation of therapy and adverse effects limit use. Topicalanthralincream (0.5 to 1% applied for 10 to 20 minutes daily then washed off; contact time titrated as tolerated up to 1 hour/day) may be used to stimulate a mild irritant reaction.Minoxidil5% solution may be helpful as an adjuvant to corticosteroid oranthralintreatment. Induction of allergic contact dermatitis using diphenylcyclopropenone or squaric acid dibutylester (topical immunotherapy) leads to hair growth due to unknown mechanisms, but this treatment is best reserved for patients with diffuse involvement who have not responded to other therapies. can also be used in combination with oral corticosteroids. Its use is typically reserved for refractory alopecia areata in patients who fail standard therapy ( Treatment reference ). Systemic and topical PUVA have been used with limited success in patients who fail conventional therapy. However, this is a less favored treatment option because of high relapse rates, lack of randomized controlled trials, and increased risk of cancer with PUVA. Baricitinibis a Janus kinase (JAK) inhibitor that is beneficial in treating alopecia areata. Hairpieces and camouflage techniques can be used to mask the effects of hair loss. 1.Strazzulla LC, Wang EHC, Avila L, et al: Alopecia areata: An appraisal of new treatment approaches and overview of current therapies.J Am Acad Dermatol78(1):15-24, 2018. doi: 10.1016/j.jaad.2017.04.1142 