Treatment of pediatric alopecia areata: A systematic review

Abstract

Background: Alopecia areata (AA) is an autoimmune, nonscarring hair loss disorder with slightly greater prevalence in children than adults. Various treatment modalities exist; however, their evidence in pediatric AA patients is lacking.Objective: To evaluate the evidence of current treatment modalities for pediatric AA. Methods:We conducted a systematic review on the PubMed database in October 2019 for all published articles involving patients \18 years old. Articles discussing AA treatment in pediatric patients were included, as were articles discussing both pediatric and adult patients, if data on individual pediatric patients were available.Results: Inclusion criteria were met by 122 total reports discussing 1032 patients. Reports consisted of 2 randomized controlled trials, 4 prospective comparative cohorts, 83 case series, 2 case-control studies, and 31 case reports. Included articles assessed the use of aloe, apremilast, anthralin, anti-interferon gamma antibodies, botulinum toxin, corticosteroids, contact immunotherapies, cryotherapy, hydroxychloroquine, hypnotherapy, imiquimod, Janus kinase inhibitors, laser and light therapy, methotrexate, minoxidil, phototherapy, psychotherapy, prostaglandin analogs, sulfasalazine, topical calcineurin inhibitors, topical nitrogen mustard, and ustekinumab.Limitations: English-only articles with full texts were used. Manuscripts with adult and pediatric data were only incorporated if individual-level data for pediatric patients were provided. No meta-analysis was performed. Conclusion:Topical corticosteroids are the preferred first-line treatment for pediatric AA, as they hold the highest level of evidence, followed by contact immunotherapy. More clinical trials and comparative studies are needed to further guide management of pediatric AA and to promote the potential use of pre-existing, low-cost, and novel therapies, including Janus kinase inhibitors.

IADVL SIG pediatric dermatology (Academy) recommendations on childhood alopecia areata

“…The use of topical corticosteroids, particularly high-potency topical corticosteroids, is supported by the literature (strongest levels of evidence [LoE] 1) and is considered a safe and effective first-line treatment option in children with patchy AA. [ 24 ] High-potency topical corticosteroids showed higher efficacy than low-potency topical corticosteroids in an RCT (randomized controlled trial) that included 41 pediatric patients. [ 25 ] They were also superior to topical tacrolimus and anthralin.…”

Intralesional triamcinolone acetonide for alopecia areata: does dilution matter?

“…The choice of treatment depends on the extent of hair loss, previous treatment responses, and the patient's age. For the treatment of localized AA with less than 50% of scalp involvement in adults, intralesional (IL) corticosteroid injection, oral corticosteroids, topical calcineurin inhibitors, and local immunotherapy (diphencyprone, anthralin) are considered the best choice 1,[5][6][7] .…”

Chronic Myeloid Leukemia: Part I—Real-World Treatment Patterns, Healthcare Resource Utilization, and Associated Costs in Later Lines of Therapy in the United States

“…25,31,32 Although a wide range of topical and systemic medications are currently used to manage AA, none are approved by the US Food and Drug Administration, and effective treatments for persistent or extensive disease remain scarce. 18,[33][34][35][36] Corticosteroids, whether in topical, injectable, or oral formulations, alone or in combination, remain the most widely prescribed treatments for adolescents with acute and extensive AA. 37,38 Additionally, calcineurin inhibitors, immunomodulators (eg, methotrexate), and Janus kinase inhibitors may be considered as options for more severe AA.…”