Patchy alopecia areata

• The spontaneous remission rate in alopecia areata is high, which makes evaluation of treatment in the absence of RCTs very difficult.

• No treatment alters the natural history of alopecia areata.

• We found no good evidence in support of non-drug treatment.

• Small RCTs have shown that intralesional injection of triamcinolone acetonide can effectively stimulate regrowth of patchy alopecia areata. Transient atrophy is common. Treatment can be repeated at 4-6 weekly intervals if necessary. We were not able to find data on long-term efficacy.

• One RCT demonstrated that potent topical corticosteroids are marginally more effective than placebo in patchy alopecia areata when used continuously for a minimum of 3 months. In observational case series, children between the ages of 3 and 10 years appear most likely to respond.

• We found one systematic review but no RCTs on the use of topical immunotherapy. A number of studies have demonstrated unilateral hair regrowth after unilateral treatment. This protocol has been favoured for evaluation of topical immunotherapy because of the inability to blind patients. The systematic review of published case series on the use of topical immunotherapy with diphencyprone concluded that 50-60% of patients achieve a worthwhile response. Patients with limited disease have higher response rates than those with alopecia totalis/ universalis.

• We found insufficient evidence on the use of topical minoxidil, topical anthralin therapy, PUVA, aromatherapy, cryosurgery and ciclosporin A.

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