The treatment of alopecia areata depends on the amount of hair loss, location of hair loss and age of the patient being treated. It is important to stress to the patient and family that treatment will not alter the course of the condition; it can not cure the condition, and it can’t prevent new areas of alopecia from occurring and the treatment does not speed up regrowth. Localized areas of alopecia areata can be treated with several modalities. Some patients may opt not to treat small localized inconspicuous areas of alopecia, this is acceptable. These areas will probably spontaneously regrow over several months to two years.
If the patient desires treatment of localized areas to speed regrowth, several options can be considered. In a child, a mid-potency topical steroid used once daily for 3 months is an easy first line of therapy. The patient is seen in follow up in 3 months, if there is no regrowth, the treatment is unlikely to be effective. Topical short-contact anthralin therapy (SCAT) or topical 5% minoxidil can then be tried. In an older child (greater than 10 to 12 years of age), intralesional steroids can be used. An adult with localized alopecia areata is usually treated with intralesional steroids (triamcinolone at a concentration of 3 to5 mg/ml).
Adults with an aversion to needles can also be treated with topical SCAT or 5% minoxidil. Adults and children with alopecia totalis or universalis must be counseled on the low efficacy of therapy. Support must be given including referrals to local support groups and referrals to reputable makers and fitters of full cranial prostheses. If an adult or adolescent with totalis or universalis desires a trial of therapy, topical immunotherapy probably has the highest efficacy. Diphenylcylopropenone (DPCP) is the most commonly used sensitizer. Up to 25% of patients with totalis or universalis will respond to this therapy.