Clinical Review

Management of alopecia areata

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c3671 (Published 23 July 2010) Cite this as: BMJ 2010;341:c3671
  1. M J Harries, clinical research fellow1,
  2. J Sun, post-doctoral fellow 2, associate professor of dermatology3,
  3. R Paus, professor of dermatology14,
  4. L E King Jr, professor of medicine (dermatology)5
  1. 1Epithelial Sciences, School of Translational Medicine, University of Manchester, Manchester
  2. 2Jackson Laboratory, Bar Harbor, ME, USA
  3. 3Department of Dermatology, China-Japan Union Hospital of JiLin University, Chang Chun, People’s Republic of China
  4. 4Department of Dermatology, University of Lübeck, D-23538 Lübeck, Germany
  5. 5Skin Disease Research Centre, Division of Dermatology, Vanderbilt Medical Center, Nashville, TN, USA
  1. Correspondence to: M Harries, University of Manchester, Salford Royal NHS Foundation Trust, Manchester M6 8HD mjharries{at}doctors.org.uk
  • Accepted 29 June 2010

Summary points

  • Alopecia areata is a common cause of patchy hair loss in adults and children and can greatly affect quality of life.

  • Spontaneous hair regrowth occurs within a year in over half of people with patchy disease.

  • Objective assessment of treatment efficacy is very difficult due to the high but unpredictable rate of spontaneous remission.

  • First line treatments are topical immunotherapy for extensive disease and intralesional corticosteroids for localised patchy hair loss.

  • Half-head treatment regimens can be used to control for spontaneous hair regrowth in trials of topical treatment.

  • Standardised trial methods with clinically meaningful endpoints should be adopted by all future studies to help identify optimal treatments

Alopecia areata is a common condition characterised by sudden onset of patchy hair loss without signs of skin inflammation or scarring. It accounts for about 2% of new referrals for dermatology in the UK and United States and has an estimated lifetime risk of 1.7%.1 Data from the National Health and Nutrition Examination Survey indicated a prevalence of 0.15% in the population of the United States.w1 The extent of hair loss can vary greatly, ranging from a single coin sized patch to very extensive alopecia involving the entire scalp and the rest of the body. The condition is unpredictable; spontaneous regrowth of hair can occur at any time during its course with the possibility of subsequent relapse. Alopecia areata is particularly difficult to manage and most of the available therapeutic options are unsatisfactory. It is a psychologically distressing disease and doctors should provide patients with realistic advice about treatments and their effectiveness.

Although several medical treatments have been reported for the condition, the evidence is quite difficult to interpret because of differing study methods, non-homogeneous patient populations, variability in outcome measures, and failure to control for spontaneous regrowth. A recent Cochrane …

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