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Alopecia Areata

Alopecia areata is a common dermatologic problem accounting for approximately 2% of new outpatient dermatology clinic visits. The course of alopecia areata is extremely variable, with some cases showing spontaneous remission and others undergoing total scalp hair loss.

Severe forms of alopecia areata are extensive or rapidly progressive and are likely to be chronic or at least chronically recurrent and often resistant to treatment.


Intralesional Steroids

Intralesional steroids are a common form of treatment for alopecia areata. This method is best used for stable patchy scalp hair loss. Patients with extensive alopecia areata, rapidly progressive disease, or hair loss greater than 2 years' duration of the current episode generally respond poorly to intralesional steroids.

Side effects of intralesional steroids include minimal transient atrophy and, rarely, follicular atrophy. Local pain at the injection site is the most frequent patient complaint; it is a significant drawback in treating children.

Topical Steroids

Topical steroids have not been extensively evaluated, although they are frequently used to treat alopecia areata, especially in children. Our experience using 0.05% betamethesone dipropionate cream in the nonoptimized vehicle (Diprosone®) parallels that reported by Pascher et al who used 0.2% fluocinolone acetonide cream (Synalar HP®). Twice daily applications of Diprosone cream without occlusion seem to work particularly well in children (even in some with 100% hair loss). This

Side effects of topical steroid therapy as outlined consist most commonly of local folliculitis and occasionally acneiform facial lesions; young children may develop reversible hypertrichosis on the face or neck. Daily shampooing and sparing applications (0.5 to 1 g applied to the entire scalp per

Systemic Steroids

Systemic steroids are most likely to be prescribed for rapidly progressive or extensive alopecia areata. It is argued by some that this form of therapy not only may stop active hair loss but also may


Anthralin is the only irritant substance generally agreed to induce hair regrowth in alopecia areata. In our experience using anthralin (Drithocreme®) applied overnight to the entire scalp in concentrations of 0.5% or 1.0% used as a short (20- to 60-minute) application, the mean time to response was

Our current therapeutic regimen for anthralin is to use the 1.0% cream (Drithocreme®) in sparing applications for a short contact (20 to 60 minutes) time on alternate days for 2 weeks and then, if


Topical minoxidil may be effective in alopecia areata, especially when used in the 5% concentration. The lower concentration (2%, Rogaine) is most likely to be effective in mild patchy alopecia areata. One study of patients with severe chronically treatment-resistant disease who received twice daily applications of 5% minoxidil to the entire scalp showed cosmetic regrowth in 4 (37%) of 11 patients

Side effects of topical minoxidil are usually minimal. Mild local irritation is seen occasionally, and rarely patients develop allergic contact dermatitis to minoxidil or to the propylene glycol in the vehicle (VCF, unpublished observation). Rarely, photoallergic contact dermatitis has been reported. Systemic


Psoralen plus ultraviolet A light (PUVA) has been evaluated as a treatment for alopecia areata in several studies. Treatments are given two to three times weekly. Time to response is reported as

Side effects of PUVA treatment generally include nausea, pigmentary changes, risk of skin cancer


Topical cyclosporin has been evaluated as a treatment for alopecia areata and generally has been


Other agents reported to have some benefit in alopecia areata include inosiplex, thymopentin, nitrogen mustard, zinc, azathioprine, imipramine, and sulfones.


Topical 5% minoxidil combined with topical steroid (0.05% betamethasone dipropionate cream applied 30 to 60 minutes later) has been evaluated in a double-blind trial and was found to be superior to either drug used alone when treating severe, treatment-resistant disease. After 16 weeks