Oftentimes when people are first diagnosed, it’s because they find a bald spot which may lead them to believe that alopecia areata is specifically about their hair and the loss of it. However, alopecia areata is more about the immune system than it is about the hair follicle itself.
Certain portions of the human body have ‘immune privilege,’ meaning they are able to tolerate the introduction of foreign substances without eliciting an inflammatory immune response. Our hair follicles (primarily the epithelium surrounding the hair follicles) are part of the skin immune system. Our skin immune system is constantly signaling and talking to keep our lymphocytes at bay — letting them know that they are, indeed, supposed to be there. Read more…
A number of treatments can help hair regrow but none alter the long-term course of the disorder. Spontaneous remission occurs in up to 80% of patients with limited patchy hair loss of short duration (< 1 year) making it difficult to assess efficacy, particularly in mild forms of alopecia areata.
Some trials have been limited to patients with severe alopecia areata where spontaneous remission is unlikely. However, these patients tend to be resistant to all forms of treatment and the failure of a treatment in this setting does not exclude efficacy in mild alopecia areata. There are numerous case reports and uncontrolled case series claiming response of alopecia areata to diverse treatments. However, few treatments have been subjected to randomized controlled trials and, except for contact immunotherapy, there are few published data on long-term outcomes.
Topical corticosteroid therapy can be useful, especially in children who cannot tolerate injections. It is administered as follows:
- Fluocinolone acetonide cream 0.2%, betamethasone dipropionate cream 0.05%, or clobetasol 0.05% foam are the most common forms prescribed
- Topical cream or foam should be applied to the affected area and 1 cm beyond the circumference of the bald patch daily
- Treatment must be continued for a minimum of 3 months before regrowth can be expected, and maintenance therapy is often necessary
- For alopecia totalis or alopecia universalis, 2.5 g of clobetasol propionate covered with a plastic film 6 days/wk for 6 months helped a minority of patients
- Side effects include skin atrophy, folliculitis, or telangiectasia
- 28.5%-61% of patients achieve regrowth — 37.5% of patients experience relapse Read more…