Consensus on the treatment of alopecia areata – Brazilian Society of Dermatology

Ramos, Paulo Müller; Anzai, Alessandra; Duque‐Estrada, Bruna; Melo, Daniel Fernandes; Sternberg, Flavia; Santos, Leopoldo Duailibe Nogueira; Alves, Lorena Dourado; Mulinari‐Brenner, Fabiane

doi:10.1016/j.abd.2020.05.006

Cited by 31 publications

(74 citation statements)

References 93 publications

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“…Combination of corticosteroids was most common among patients with moderate AA which is consistent with recommendations to prescribe topical as first-line treatment for cases and the ineffectiveness of topical or injectable corticosteroids alone in more severe types of AA [3,16]. Combination with or solo immunomodulator was almost exclusive to patients with severe AA, likely due to concerns about treatment side effects [17].…”

Section: Discussionsupporting

confidence: 63%

Treatment Patterns and Treatment Satisfaction Among Adults with Alopecia Areata in the United States

Fridman¹,

Ray

Gandhi

et al. 2022

Adv Ther

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Introduction: Alopecia areata (AA), an autoimmune disease, is characterized by non-scarring hair loss involving the scalp, face, and/or body. Prior to 2022, no US Food and Drug Administration (FDA)-approved treatments for AA were available in the USA; existing treatment options had limited efficacy and durability and are often associated with side effects. This study aimed to evaluate the current AA treatment patterns and treatment satisfaction as reported by dermatologists. Methods: Real-world data from a 2019 crosssectional survey of US dermatologists and their adult patients with AA were analyzed. Dermatologists provided comprehensive data on their patients with AA, including AA dermatologistassessed severity, treatments, treatment

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Section: Discussionsupporting

confidence: 63%

Treatment Patterns and Treatment Satisfaction Among Adults with Alopecia Areata in the United States

Fridman¹,

Ray

Gandhi

et al. 2022

Adv Ther

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“…A literature review found two overseas AA treatment guidelines and two expert consensus reports 2–5 . All of them recommend topical corticosteroids, intralesional corticosteroid injections, and contact immunotherapy as treatment modalities (Table 1).…”

Section: Current Management Strategymentioning

confidence: 99%

Alopecia areata: Current understanding of the pathophysiology and update on therapeutic approaches, featuring the Japanese Dermatological Association guidelines

Fukuyama

Ito

Ohyama

2021

The Journal of Dermatology

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Alopecia areata (AA) is a relatively common nonscarring hairloss disease characterized by an autoimmune response to anagen hair follicles (HFs). Accumulated evidence suggests that collapse of the HF immune privilege subsequent to triggering events, represented by viral infection, leads to autoimmune response in which autoreactive cytotoxic CD8+NKG2D+ T cells mainly target exposed HF autoantigens. AA had been recognized as type 1 inflammatory disease, but recent investigations have suggested some roles of type 2‐ and Th17‐associated mediators in AA pathogenesis. The significance of psychological stress in AA pathogenesis is less emphasized nowadays, but psychological comorbidities, such as depression and anxiety, attract greater interest in AA management. In this regard, the disease severity may not solely be evaluated by the extent of hair loss. Use of trichoscopy markedly improved the resolution of the diagnosis and evaluation of the phase of AA, which is indispensable for the optimization of treatment. For the standardization of AA management, the establishment of guidelines/expert consensus is pivotal. Indeed, the Japanese Dermatological Association (JDA) and other societies and expert groups have published guidelines/expert consensus reports, which mostly recommend intralesional/topical corticosteroid administration and contact immunotherapy as first‐line treatments, depending on the age, disease severity, and activity of AA. The uniqueness of the JDA guidelines can be found in their descriptions of intravenous corticosteroid pulse therapy, antihistamines, and other miscellaneous domestically conducted treatments. Considering the relatively high incidence of spontaneous regression in mild AA and its intractability in severe subsets, the importance of course observation is also noted. Evidenced‐based medicine for AA is currently limited, however, novel therapeutic approaches, represented by JAK inhibitors, are on their way for clinical application. In this review, the latest understanding of the etiopathogenesis and pathophysiology, and update on therapeutic approaches with future perspectives are summarized for AA, following the current version of the JDA AA management guidelines.

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“…Unlike topicals, ILTA bypasses the epidermis when injected, achieving direct access to the HF. 14 High-quality controlled studies regarding the use of ILTA in AA are scarce. A meta-analysis concluded that 5 mg/mL and 10 mg/mL of ILTA diluted in NS were equally effective (80.9% [P<.05] vs 76.4% [P<.005], respectively).…”

Section: Commentmentioning

confidence: 99%

Unique Treatment for Alopecia Areata Combining Epinephrine With an Intralesional Steroid

Stratulat¹

2022

Cutis

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Alopecia areata (AA) is an autoimmune disorder characterized by well-demarcated patches of hair loss with preservation of the hair follicle (HF). It generally is a nonscarring alopecia that can be extensive and refractory to treatment. We propose modification to an already widely used first-line treatment by diluting intralesional triamcinolone acetonide (ILTA) to 2.5 mg/mL in 1% lidocaine and epinephrine 1:100,000 in place of normal saline (NS). Our 2 cases of severe AA are among many in our practice that responded with seemingly permanent hair regrowth using this novel combination regimen. We hypothesize that local vasoconstriction due to epinephrine potentiates the ILTA and that epinephrine also may play an independent role.

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Consensus on the treatment of alopecia areata – Brazilian Society of Dermatology

Cited by 31 publications

References 93 publications

Treatment Patterns and Treatment Satisfaction Among Adults with Alopecia Areata in the United States

Treatment Patterns and Treatment Satisfaction Among Adults with Alopecia Areata in the United States

Alopecia areata: Current understanding of the pathophysiology and update on therapeutic approaches, featuring the Japanese Dermatological Association guidelines

Unique Treatment for Alopecia Areata Combining Epinephrine With an Intralesional Steroid

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