-1-

CPG. for Alopecia areata

Alopecia areata

Alopecia areata

alopecia totalis

alopecia universalis

2.

2.1

2.2

2.3

(EXCLAMATION-MARK HAIR)
ACTIVE

2.4
(PITTING NAIL)

3.

VDRL
ANA

1.

-2-

CPG. for Alopecia areata

Alopecia areata
Extent of scalp involvement
<50%

>50%

topical steroid
or
intralesional steroid
+/3-5% minoxidil
l ti
good

topical
immunotherapy

good

poor

short contact
anthralin
good

good

poor

PUVA or immunomodulator
drug
topical steroid
or
intralesional steroid
+/3-5% minoxidil solution
or
short contact anthralin

Topical

-3
1. :
6
alopecia totalis alopecia
universalis

2.


active

3
1. Standard treatment
. Topical treatment
1.1 topical corticosteroid:
moderate strength 1-2
1.2 topical minoxidil 3-5%: 2
topical steroid
anthralin Immunostimulator
50% alopecia
totalis

Immunostimulator
2
1.3.1 Topical irritant anthralin

0.51% 10 - 60

CPG. for Alopecia areata

3
1.3.2 Topical immunogens
immunogens
(sensitization) immunogen
allergic contact dermatitis
Diphenylcyclopropenone (DCP), Squaric acid dibutylester
(SADBA) Dinitro-chlorobenzene (DNCB)
immunogen
2% DCP in
acetone 5 x 5 .
2
eczema eczema
0.001% DCP in
acetone
1
mild eczematous reaction

8 - 12

. Systemic treatment
- Intralesional corticosteroid
triamcinolone
acetonide 5-10 mg/ml
1-2 ml 4-6
dermal
atrophy

-42. Alternative treatment

2.1 Systemic Corticosteroid

50%
alopecia totalis
1 mg/kg/day

systemic
Corticosteroid

2.2 Psoralen plus ultraviolet light

(PUVA) 50%
alopecia totalis
psoralen (0.6
mg/kg) UVA
2-3
3.

3.1 Immunomodulator Inosiplex,

Cyclosporin, Azathioprine

CPG. for Alopecia areata

50%
50%

- 50%

topical intralesional corticosteroid

topical minoxidil
short contact topical anthralin
topical immunotherapy
- 50%
topical immunotherapy
PUVA immunosuppressive
drug

1. alopecia totalis alopecia universalis
2.
(ophiasis)
3. atopy
4.
5.

1.

2.


3.
4.

5.

-5-

CPG. for Alopecia areata

References
1. Olsen E, Hordinsky M., McDonald-Hull S.
et al: Alopecia areata investigational
assessment guidelines. J Am Acad Dermatol
1999; 242-6.
2. Olsen AE: hair disorders in Fitzpatrick TB
et al: Dermatology in general medicine. 5th
ed. New York, McGraw-Hill; 1999. p.737-9.
3. Dawber RPR., deBerker D., Wojnarowska
F. Disorders of hair. In: Champion RH,
Burton JL, editors.
Textbook of
th
dermatology, vol. 4. 6 ed. Oxford,
Blackwell Scientific Ltd; 1998. p.2919-27.
4. Fiedler VC, Alaiti S. Treatment of
alopecia areata. Dermatol Clin 1996; 14(4):
733-8.
5. Shapiro J and Madani S. Alopecia areata:
diagnosis and management. Dermatology
1999; 38 (suppl 1): 19-24.