This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Go to /pro/cpd-dashboard page

This page is worth 0.05 CPD credits. CPD dashboard

Go to /account/subscription-details page

This page is worth 0.05 CPD credits. Upgrade to Pro

Diagnosis and treatment

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Diagnosis and treatment

Fungal infections should be excluded especially when the lesion is slightly atypical (when scaling is present) (1).

Active hair shedding can be demonstrated by the "pull test" - grasping and pulling around 60 hairs from the periphery of the lesion between the finger and thumb. If 2-10 hairs are obtained the test is positive (1) Treatment options depend on the extent of hair loss and the patients' preference (1).

Treatment of non-extensive alopecia areata (less than 50% hair loss) includes:

  • Watchful waiting - the condition is self-limiting so the best plan is to reassure the patient and to encourage patience since spontaneous regrowth may not be visible for up to 3 months. A placebo is often useful eg. a short course of UVB. If treatment is preferred by the patient
  • Referral to a dermatologist for the use of intralesional corticosteroids (ILCs) - ILCs is the most effective treatment options for patients with non-extensive alopecia areata
  • topical corticosteroids and topical minoxidil - can be used on patients (over 16 years of age) who are waiting for a dermatologist referral or on patients who want treatment in primary care only
  • Psychological counseling (1)

Treatment of extensive alopecia areata (more than 50% hair loss) includes:

  • Watchful waiting - spontaneous remission may occur, but is less likely than non-extensive alopecia areata
  • Early dermatological referral for treatment with topical immunotherapies (eg, contact sensitizers such as diphencyprone or squaric acid dibutylester), topical minoxidil, and cyclosporin
    • however, for many patients, therapy is limited by poor efficacy and/or problems with toxicity ¢ topical corticosteroids and topical minoxidil - can be considered for patients who are waiting for dermatologist referral or for patients who wants treatment in primary care only
  • Psychological counseling
  • A wig is indicated for more severe and extensive hair loss (1).

Study evidence revealed that efalizumab was not effective in promoting hair regrowth in a small cohort of patients with moderate-to-severe alopecia areata (2).

Reference:


Related pages

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.