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Management of alopecia areata

Andrew G Messenger, MD, FRCP
Section Editors
Robert P Dellavalle, MD, PhD, MSPH
Maria Hordinsky, MD
Deputy Editor
Abena O Ofori, MD


Alopecia areata is a chronic, relapsing immune-mediated inflammatory disorder affecting hair follicles resulting in nonscarring hair loss. The severity of the disorder ranges from small patches of alopecia on any hair-bearing area to the complete loss of scalp, eyebrow, eyelash, and body hair.

Although up to 50 percent of patients who present with patchy alopecia areata experience spontaneous hair regrowth within one year, most will relapse [1]. The unpredictable course of the disease and the psychological distress associated with hair loss prompt many patients to seek therapy. (See "Clinical manifestations and diagnosis of alopecia areata", section on 'Course of disease'.)

The management of alopecia areata involves both addressing the psychological needs of the patient and offering treatment to patients who desire intervention. A variety of topical, intralesional, and systemic agents, as well as devices, have been used for alopecia areata, but the response to treatment varies widely, and few well-designed clinical trials have evaluated these therapies [2].

Options for the management of alopecia areata will be discussed here. The clinical manifestations and diagnosis of the disorder are reviewed separately. (See "Clinical manifestations and diagnosis of alopecia areata".)


Based upon the relative safety and the available, although limited, evidence for the efficacy of these agents, intralesional or topical corticosteroids are the initial treatment for most patients with patchy alopecia areata [1]. Topical immunotherapy can be used as first-line treatment for patients with extensive disease (greater than 50 percent scalp hair loss).


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