• Alopecia areata treatment introduction
• Alopecia areata treatment introduction references

Alopecia areata treatment introduction

Here we take a look at the treatment options for alopecia areata. None of this text should be construed as advice or recommendation in any shape or form. Patchy alopecia areata of less than one year duration is more likely to respond to treatment with a success rate estimated at 75%. Alopecia areata that has persisted, with or without treatment for more than two years is less likely to respond to further treatment. Only about 40% of people with long term hair loss respond to treatment.

Potentially everyone with alopecia areata is capable of regrowing hair even after many years of hair loss and spontaneous regrowth often occurs in people with alopecia areata. However, there is no permanent cure for alopecia areata and there is no universally proven therapy for inducing remission. There are a range of therapies for which partial success has been claimed but as soon as any of the therapies are stopped alopecia areata returns. All the current modalities used are more effective in those with milder forms of the disease but much less effective in people with extensive hair loss. The various therapies can be divided up into several groups.

• 1) Non specific irritants: Anthralin, croton oil, dithranol.
  
• 2) Contact dermatitis inducers: Dinitrochlorobenzene (DNCB), diphenylcyclopropenone (DPCP), squaric acid dibutyl ester (SADBE).
  
• 3) Non specific immunosuppressants: Corticosteroids, 8-methoxypsoralen plus ultra violet A light (PUVA), phototherapy.
  
• 4) Specific immunosuppressants: Cyclosporin (CyA), Neoral, Tacrolimus (FK506) .
  
• 5) Treatments of direct action on the hair follicle: Minoxidil.
  
• 6) Alternative treatments: essential oils, acupuncture.
  
• 7) Experimental treatments: cytokines, biologicals.
  
• 8) Theoretical treatments: Desensitization, oral tolerance, gene therapy, new immunosuppressant drugs.
  

Dermatologists usually have a list of favored treatments that are most effective in their experience. They run through this list until they find something that works or until they run out options. Frequently corticosteroids are the first option particularly for people with patchy, limited alopecia areata. With more extensive hair loss dermatologists generally prefer using contact dermatitis inducers. Not all treatments are readily available in the USA as they have not been certified by the FDA for alopecia areata treatment. DPCP falls into this category and is only available from a few dermatologists as an experimental treatment. However, it is more widely available in Europe.

Please note that there are significant problems in defining and comparing the success rate for different treatments. Very few treatment trials have been true double blind trials involving people receiving placebos. Many reports on trials involve perhaps a few dozen patients and no control group for comparison. One of the greatest problems is the inability to compare trials using different treatments. Without age matched groups with alopecia areata of similar extent and duration, plus the different parameters individual clinicians use to define satisfactory hair regrowth, make comparison between different treatment types very difficult.

Alopecia areata treatment introduction references

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