Management of alopecia areata in adults

JAK: Janus kinase.

* Alopecia areata has an unpredictable course that includes the possibility of persistence, progression, relapse, and spontaneous remission. Some patients may elect to defer treatment or try cosmetic options. Resources for psychosocial support, such as support groups, psychologists, or psychiatrists, may be helpful. Refer to UpToDate content on the clinical manifestations and management of alopecia areata for details.

¶ Severity categories are not strictly defined. Other factors may influence the selection of the most appropriate treatment.

Δ Intralesional corticosteroid therapy is typically administered every 4 to 6 weeks, and a response is often evident within 6 to 8 weeks. If a response does not occur within 6 months, treatment should be discontinued.

◊ High-potency topical corticosteroid therapy is an alternative for patients who cannot tolerate intralesional corticosteroid injections. A medium-potency topical corticosteroid is used for the initial treatment of facial involvement, with the option for switching to a high-potency corticosteroid if there is no response. A topical corticosteroid should be discontinued if there is no response after 3 months of scalp treatment or 6 weeks of facial treatment.

§ We typically taper corticosteroid therapy over 3 to 6 months rather than stop abruptly. We do not taper intralesional corticosteroid injections.

¥ Topical immunotherapy is favored when systemic therapy is not appropriate or feasible or the patient prefers to avoid systemic treatment. We discontinue the JAK inhibitor if there is no response after 6 months. We discontinue topical immunotherapy if there is no response after 6 to 12 months.