Alopecia areata. Diagnostic and therapeutic recommendations
of the Polish Society of Dermatology. Part 2: Treatment

Rakowska, Adriana; Rudnicka, Lidia; Olszewska, Małgorzata; Bergler‐Czop, Beata; Czuwara, Joanna; Brzeźińska-Wcisło, Ligia; Placek, Waldemar; Zegarska, Barbara

doi:10.5114/dr.2023.127705

Cited by 3 publications

(15 citation statements)

References 98 publications

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“…Vitamins and other dietary supplements have no therapeutic significance in alopecia areata. 16 There are no official European recommendations in this regard. The FDA issued a recommendation not to use biotin in patients with hair loss unless there is a documented biotin deficiency.…”

Section: Other Therapeutic Optionsmentioning

confidence: 99%

“…Treatment duration with glucocorticosteroids should be limited if possible to reduce the risk of adverse events. 13,19 To minimize the risk of relapses, treatment should ideally be continued for at least 6-12 months after complete hair regrowth, 16,19 before a possible switch to maintenance therapy or discontinuation. Detailed standards for maintenance therapy are still to be established and defined after specific clinical trials.…”

Section: Treatment Duration and Follow-upmentioning

confidence: 99%

“…week) is also used in some countries in the treatment of alopecia areata. 16 The use of intravenous methylprednisolone in pulses, currently is not recommended by most experts because of a low durability of the therapeutic effects. 19 The use of systemic glucocorticosteroids in monotherapy should be limited to patients in whom combined therapy is impossible or contraindicated.…”

Section: Severe ≥50mentioning

confidence: 99%

“…19 The use of systemic glucocorticosteroids in monotherapy should be limited to patients in whom combined therapy is impossible or contraindicated. 16 Also, a course of systemic glucocorticosteroids in monotherapy may be considered as an initiation therapy in patients with active alopecia areata.…”

Section: Severe ≥50mentioning

confidence: 99%

“…It can be administered subcutaneously or orally. The typical dose ranges from 15 to 25 mg/week 16,19 for both ways of administration.…”

Section: Methotrexatementioning

confidence: 99%

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European expert consensus statement on the systemic treatment of alopecia areata

Rudnicka,

Arenbergerova,

Grimalt

et al. 2024

Acad Dermatol Venereol

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Alopecia areata is an autoimmune form of non‐scarring hair loss. It is usually characterized by limited areas of hair loss. However, the disease may progress to complete scalp and body hair loss (alopecia totalis, alopecia universalis). In patients with alopecia areata hair loss significantly impacts the quality of life. Children and adolescents with alopecia areata often experience bullying, including physical aggression. The disease severity evaluation tools used in clinical practice are: the Severity of Alopecia Tool (SALT) score and the Alopecia Areata Scale (AAS). A SALT score equal to or greater than 20 constitutes a commonly accepted indication for systemic therapy in alopecia areata. When using the AAS, moderate to severe alopecia areata should be considered a medical indication for systemic treatment. Currently, the only two EMA‐approved medications for alopecia areata are baricitinib (JAK 1/2 inhibitor) for adults and ritlecitinib (JAK 3/TEC inhibitor) for individuals aged 12 and older. Both are EMA‐approved for patients with severe alopecia areata. Other systemic medications used off‐label in alopecia areata include glucocorticosteroids, cyclosporine, methotrexate and azathioprine. Oral minoxidil is considered an adjuvant therapy with limited data confirming its possible efficacy. This consensus statement is to outline a systemic treatment algorithm for alopecia areata, indications for systemic treatment, available therapeutic options, their efficacy and safety, as well as the duration of the therapy.

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Section: Other Therapeutic Optionsmentioning

confidence: 99%

Section: Treatment Duration and Follow-upmentioning

confidence: 99%

Section: Severe ≥50mentioning

confidence: 99%

Section: Severe ≥50mentioning

confidence: 99%

“…It can be administered subcutaneously or orally. The typical dose ranges from 15 to 25 mg/week 16,19 for both ways of administration.…”

Section: Methotrexatementioning

confidence: 99%

See 3 more Smart Citations

European expert consensus statement on the systemic treatment of alopecia areata

Rudnicka,

Arenbergerova,

Grimalt

et al. 2024

Acad Dermatol Venereol

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Deciphering the Complex Immunopathogenesis of Alopecia Areata

Šutić Udović,

Hlača,

Massari

et al. 2024

IJMS

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Alopecia areata (AA) is an autoimmune-mediated disorder in which the proximal hair follicle (HF) attack results in non-scarring partial to total scalp or body hair loss. Despite the growing knowledge about AA, its exact cause still needs to be understood. However, immunity and genetic factors are affirmed to be critical in AA development. While the genome-wide association studies proved the innate and acquired immunity involvement, AA mouse models implicated the IFN-γ- and cytotoxic CD8+ T-cell-mediated immune response as the main drivers of disease pathogenesis. The AA hair loss is caused by T-cell-mediated inflammation in the HF area, disturbing its function and disrupting the hair growth cycle without destroying the follicle. Thus, the loss of HF immune privilege, autoimmune HF destruction mediated by cytotoxic mechanisms, and the upregulation of inflammatory pathways play a crucial role. AA is associated with concurrent systemic and autoimmune disorders such as atopic dermatitis, vitiligo, psoriasis, and thyroiditis. Likewise, the patient’s quality of life (QoL) is significantly impaired by morphologic disfigurement caused by the illness. The patients experience a negative impact on psychological well-being and self-esteem and may be more likely to suffer from psychiatric comorbidities. This manuscript aims to present the latest knowledge on the pathogenesis of AA, which involves genetic, epigenetic, immunological, and environmental factors, with a particular emphasis on immunopathogenesis.

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Trichoscopy in the Diagnosis of Alopecia Areata

Todorova

2024

Dermatology - The Latest Research on the Most Common Diseases [Working Title]

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Alopecia areata (AA) is one of the most common hair loss disorders, with a prevalence of 0.1% - 0.2% of the general population. AA is regarded as a T-cell-mediated autoimmune condition characterized by non-scarring hair loss affecting only parts of the scalp, the entire scalp, or parts of the body. AA may manifest as a single episode or may have a relapsing course. Dermoscopy of the hair and scalp is known as trichoscopy. It is a useful method for diagnosing and monitoring hair and scalp disorders, as well as monitoring the effect of the applied treatment. The presence of exclamation mark hairs, black dots, triangular hairs, broken hairs, and pointed hairs in the alopecic patches indicates disease activity. One of the most common trichoscopic features of AA are the yellow dots - empty follicular openings filled with keratin and sebum. They predominate in long-standing, inactive diseases. Short vellus hairs are also common. The hair regrowth phase includes upright regrowing hairs and circle hairs. Diagnosis should be based on the coexistence of several trichoscopic findings rather than the presence of a single sign.

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Alopecia areata. Diagnostic and therapeutic recommendations of the Polish Society of Dermatology. Part 2: Treatment

Cited by 3 publications

References 98 publications

European expert consensus statement on the systemic treatment of alopecia areata

European expert consensus statement on the systemic treatment of alopecia areata

Deciphering the Complex Immunopathogenesis of Alopecia Areata

Trichoscopy in the Diagnosis of Alopecia Areata

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