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Therapeutic Approach

Alopecia areata is an inflammatory nonscarring type of hair loss that can manifest as a variety of clinical presentations, ranging from small, well circumscribed areas of patchy hair loss to a confluent loss of body and scalp hair. Though the exact pathophysiology of alopecia areata has yet to be elucidated, it is hypothesized to be due to loss of immune privilege of the hair follicle. Although spontaneous regrowth and remission can sometimes be observed, management remains challenging and nonuniform, as there are currently no curative treatments that have been proven to induce and sustain remission. There currently exist no FDA-approved therapies for the management of alopecia areata. Therapeutic choice should be guided by individual and disease characteristics, including patient age and the severity of disease as determined by area of scalp involvement or Severity of Alopecia Tool (SALT) score. The authors recommend topical corticosteroids (mometasone) +/− topical 5% minoxidil for patients less than 10 years old. For patients over 10 years old with less than 50% scalp involvement, topical corticosteroids +/− intralesional corticosteroids +/− topical 5% minoxidil should be first-line therapy. For patients without a successful response, topical immunotherapy is the next line of therapy. For patients over 10 years old with greater than 50% scalp involvement, topical immunotherapy or JAK inhibitors +/− intralesional corticosteroids are recommended. See Table 79-1.

Table 79-1Alopecia Areata Treatment Table

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