A

Alopecia Areata: Evidence-Based Treatments

Seema Garg and Andrew G. Messenger
Alopecia areata is a common condition causing nonscarring hair loss. It may e patchy!
involve the entire scalp "alopecia totalis# or whole ody "alopecia universalis#. $atients may
recover spontaneously ut the disorder can %ollow a course o% recurrent relapses or result
in persistent hair loss. Alopecia areata can cause great psychological distress! and the
most important aspect o% management is counseling the patient aout the unpredictale
nature and course o% the condition as well as the availale e%%ective treatments! with details
o% their side e%%ects. Although many treatments have een shown to stimulate hair growth
in alopecia areata! there are limited data on their long-term e%%icacy and impact on &uality
o% li%e. 'e review the evidence %or the %ollowing commonly used treatments: corticosteroids
"topical! intralesional! and systemic#! topical sensiti(ers "diphenylcyclopropenone#! psor-
alen and ultraviolet A phototherapy "$)*A#! mino+idil and dithranol.
Semin ,utan Med Surg -.:/0-/. 1 -223 Elsevier Inc. All rights reserved.
lopecia areata "AA# is a chronic in%lammatory condition caus-
ing nonscarring hair loss. The li%etime ris4 o% developing the
condition has een estimated at /.56 and it accounts %or /6 to -6
o% new patients seen in dermatology clinics in the )nited 7ingdom
and )nited States.
/
The onset may occur at any age8 however! the
ma9ority ":26# commence e%ore -2 years o% age.
-
There is e&ual
distriution o% incidence across races and se+es. In recent decades!
the role o% genetic predilection has started to e e+plained.
Appro+- imately -26 o% a%%ected people have a %amily history o%
the disease! suggesting a genetic predisposition.
;
A small twin
study %ound an inherited component in appro+imately 006 o%
those a%%licted y the disease! suggesting there is also a
contriution %rom environmental %actors.
<
Associations have een
reported with chromosome -/ "in- creased incidence in =own>s
syndrome#! ma9or histocompatiility comple+! and cyto4ine and
immunogloulin genes indicating a polygenic asis. A genome-
wide scan identi%ied additional loci that
also are implicated in other hair disorders and psoriasis.
0
AA is considered a tissue-restricted autoimmune condition as
the result o% association with other autoimmune diseases! oth
within the a%%ected person and their %amily. ,irculating antiodies
against %ollicular components are detected more %re&uently in
people with AA.
:!5
A hallmar4 o% AA is a periular lymphocytic
in%iltrate that consists primarily o% activated T-lymphocytes.
.
E+periments using human hair %ollicles transplanted onto
immunoincompetent mice strongly implicate a T-cell?mediated
pathomechanism.
3
A%%ected people develop single or multi%ocal smooth! well-circum-
scried patches with short ro4en hairs at the periphery "e+clamation
mar4 hairs#. The pattern and severity o% hair loss varies greatly.
All hair-earing s4in may e involved! with appro+imately /26 o%
those
=epartment o% =ermatology! @oyal Aallamshire Aospital! She%%ield! )nited
7ingdom.
Address correspondence to: A. G. Messenger! =epartment o% =ermatology!
@oyal Aallamshir e Aospital ! Glosso p @oad! She%%ield S/2 -BC! )7. E-
mail: a.g.messengerDshe%%ield.ac.u4
with AA having nail involvement. @ecovery can occur spontaneously!
although hair loss can recur and progress to alopecia totalis "total loss
o% scalp hair# or universalis "oth ody and scalp hair#. =iagnosis is
usu- ally made clinically! and investigations usually are unnecessary.
$oor prognosis is lin4ed to the presence o% other immune diseases!
%amily history o% AA! young age at onset! nail dystrophy! e+tensive
hair loss! and ophiasis "AA o% the scalp margin#.
/2
AA can cause signi%icant psychological prolems. The unpredict-
ale nature o% the condition! with apparent improvement %ollowed
y deterioration can e distressing. Ene o% the most important as-
pects o% management is counseling the patient and the %amily
mem- ers o% a young child aout the nature and course o% the
condition as well as the availale e%%ective treatments with details
o% what they involve and their side e%%ects.
Treatment
The hair %ollicle in AA is not destroyed. There%ore! there is potential
%or regrowth! although there is no cure and no treatment has een
shown to alter the course o% the disease. Many treatments can
induce hair growth. Aowever! assessing e%%icacy is di%%icult in patchy
AA as a result o% the %re&uency o% spontaneous recovery. En the
other hand! studies incorporating patients with severe disease are
hampered y the poor response to any %orm o% treatment in this
group o% patients.
There are %ew randomi(ed controlled trials o% treatments %or
AA!
//
although %or common treatment modalities none have shown
a signi%icant long-term ene%it compared with placeo. There are
numerous reports o% treatments %or AA that have assessed
e%%icacy with less-than-ideal criteria. Many o% these studies and
reports are o% dout%ul value8 however! some treatments that have
not een eval- uated in randomi(ed controlled trials may ene%it
some patients.
Fo Treatment
Because there is a high proportion o% spontaneous recovery! with ;<6
to 026 recovering within / year!
/-
not all patients re&uire treatment.
/2.0-0:-3G23GH-see %ront matter 1 -223 Elsevier Inc. All rights reserved. 15
doi:/2./2/:G9.sder.-22../-.22-
16 S. Garg and A.G. Messenger
Aowever! the relapsing nature o% the disease needs to e discussed
with patients. $atients with AA normally are highly motivated and
compli- ant! ut some patients may not want treatment or may not
respond and alternatives such as wigs! should also e discussed.
,orticosteroids
Topical ,orticosteroids
$otent topical steroids are widely used to treat AA! ut the
evidence %or their e%%icacy is limited. A /--wee4 within-patient
study "right vs. le%t side o% scalp# in moderate-to-severe disease with
a 2.206 clo- etasol propionate %oam %ormulation showed
regrowth o% at least
026 in 5 o% ;< o% the treated sites compared with / o% ;< on the
nontreated sites.
/;
A previous study o% 2.206 cloetasol propionate
under occlusion in patients with alopecia universalisGtotalis showed
that -36 "n .# ene%ited8 however ; patients! relapsed in the
:-month %ollow-up! giving a /5..6 overall long-term ene%it.
/<
In
a
randomi(ed study comparing etamethasone valerate %oam to eta-
methasone dipropionate lotion in :/ patients with mild-to-moder-
ate AA! the %oam %ormulation produced signi%icantly greater re-
growth at /- wee4s.
/0
Aowever! a study y ,haruwichitratana et
al
/:
o% 2.-06 deso+imetasone cream in moderate alopecia %ailed
to show signi%icant ene%it over placeo a%ter /- wee4s o%
treatment.
Intralesional ,orticosteroids
Intralesional corticosteroids also are used %re&uently in AA. Their
use was %irst descried in /30. with the use o% hydrocortisone.
/5
Steroids with low soluility are pre%erred %or their slow asorption
%rom the in9ection site! promoting ma+imum local action with min-
imal systemic e%%ect. A study o% intralesional corticosteroids showed
the time %rom in9ection to visile hair growth was --< wee4s and
su- se&uent growth occurred at a constant linear rate. Tu%ts grew at
;; o% ;< sites in9ected with triamcinolone he+acetonide and at /: o%
-0 in9ected with triamcinolone acetonide.
/.
The steroid is in9ected
into the upper su cutis every < to : wee4s. $reparations used
include triamcinolone acetonide "0-/2 mgGmI# and hydrocortisone
acetate "-0 mgGmI#. There are no randomi(ed controlled trials on
intralesional steroids. An uncontrolled study %rom Saudi Araia %ound
:;6 o% patients receiving monthly triamcinolone in9ections showed
complete regrowth. The out- come was more %avorale in younger
adults with less than 0 patches o% short duration "less than / month#
and less than ; cm diameter.
/3
Side e%%ects are minimal. S4in atrophy
is common ut resolves within a %ew months. The ris4 o% prolonged
atrophy can e reduced y the use o% smaller &uantities! limiting the
numer o% in9ections per site and ensur- ing the in9ection is not too
super%icial. Intralesional corticosteroids are most suitale %or patchy!
relatively stale hair loss o% limited e+tent. This modality is not
appropriate in rapidly progressive AA or in alopecia
totalisGuniversalis.
Systemic ,orticosteroids
Systemic corticosteroids have een used in the treatment o% AA
since the /302s.
-2
There is little dout that systemic steroid
treatment will induce hair regrowth ut! in patients with more
severe %orms o% the disease! relapse is common when treatment is
discontinued. ,on- cerns over the side e%%ects o% long-term
treatment mean that many physicians are not prepared to use
systemic steroids to treat alopecia areata.
-/
In an attempt to reduce
systemic side e%%ects! various high- dose pulsed therapy regimens
have een tried. @egimens include prednisolone! - g intravenous
single dose or 2.0 g daily %or 0 days!
--
alternating daily dose!
-/
tapering oral dose over : wee4s!
-;
intrave- nous
methylprednisolone -02 mg twice daily %or ; days
-<
and ;22 mg
monthly %or at least < months.
-0
Most studies have reported a
good initial response to therapy! ranging %rom //.<6 to <56.
Aow- ever! ene%it is only maintained while the patient continues
treat-
16 S. Garg and A.G. Messenger
ment. A randomi(ed controlled trial showed patients receiving -22
mg prednisolone once wee4ly %or ; months were more li4ely to
develop signi%icant regrowth than were those given placeo. Aow-
ever! -06 relapsed within ; months o% discontinuation o% treat-
ment.
-:
Two other studies %ound! a%ter an initial response! that :
months to /0 months a%ter treatment there was no sustantial en-
e%it.
-/!--
A %urther trial showed -6 mino+idil lotion %ollowing :
wee4s o% tapering prednisolone may decrease the hair loss.
-;
$ulsed corticosteroids appear to e well tolerated. Aowever! those
receiv- ing daily or alternate day oral regimes developed the
e+pected side e%%ects! including: acne! oesity! mild
hypertension! impaired A,TA reserve! and lenticular opacities.
-/
Eral steroids appear to wor4 well initially on recent-onset disease!
ut ophiasis and univer- salis respond poorly.
-<
,ontact Immunotherapy
,ontact immunotherapy is de%ined as the induction and periodic
elicitation o% an allergic contact dermatitis y topical application o%
a potent contact allergen. Topical sensiti(ers have een the
mainstay o% treatment in severe AA since /35: when
dinitrochloroen(ene "=F,B# was %irst used. As the result o%
concerns over the mutagenic properties o% =F,B in Salmonella
enteritides serotype typhimurium and its asorption through the
s4in with ultimate e+cretion in urine! its use has een
discontinued. S&uaric acid diutylester "SA=BE# has also een
used ecause it is not mutagenic in the Salmonella microsome
test. Aowever! it is e+pensive and not as stale in acetone as
diphenylcyclopropenone "=$,$#. =$,$! %irst introduced y
Aapple!
-5
has ecome the topical sensiti(er o% choice. It shows no
mutagenic properties in the Ames test.
-.
A precursor o% =$,$ is a
potent mutagen and may e a potential contaminant in
commercial samples! although 'il4erson %ound no detectale
contaminants in their analysis o% commercial =$,$. It is solule in
acetone ut it is very light sensitive and must e shielded %rom
light.
The mechanism o% action o% topical sensiti(ers is poorly under-
stood. S4in treated with topical sensiti(ers shows decreases in the
periular ,=<G,=. lymphocyte ratio!
-3
supporting a theory o%
immunomodulation. Theories include the contact sensiti(er allow-
ing %or the recovery o% the hair %ollicle y driving autoreactive T
cells into activation-induced cell death!
;2
antigenic competition!
;/
and modulation o% proin%lammatory cyto4ines in the %ollicular
milieu.
;-
$atients are %irst sensiti(ed y the use o% -6 =$,$ in acetone
applied to the scalp. Ene wee4 later! i% there is no evidence o%
severe dermatitis! treatment egins with a 2.22/6 solution. This
is re- peated wee4ly at increasing concentration until erythema
and pru- ritus are oserved! and then wee4ly treatments are
continued at the concentration that induces a mild dermatitis
reaction. Treatment generally has to e continued inde%initely or
intermittently in re- sponders. Most practitioners discontinue
treatment a%ter : months i% there is no sign o% hair regrowth.
Aowever! one study reported an increased response rate in patchy
alopecia! ut not in totalisGuniver- salis! when treatment was
continued %or up to ;- months.
;;
Epin- ions are divided over
whether patients should e allowed to treat themselves. The most
common side e%%ects are occipital and cervical lymphadenopathy
and ec(ematous eruptions! which may e+tend to other ody sites.
Ether side e%%ects include scalp edema! high %ever! vitiligo!
;<
contact urticaria
;0
and the pigmentary disturance Jdys- chromia
in con%etti!K which is more %re&uent in dar4er s4in.
Initially Aapple! and colleagues
-5
%ound :56 o% treated patients
had a satis%actory response to =$,$. The large study y van der
Steen and colleagues
;:
o% /;3 patients showed a response rate o%
02.<6. A review o% /5 reported case series concluded that 02-:26
o% patients achieve a worthwhile response to =$,$! ut the range
Alopecia areata 17
was very wide "3-.56#.
;5
=espite good initial e%%ects! the true
long-term e%%icacy is di%%icult to assess. Gordon and colleagues
%ollowed ;- responders %or an average o% ;2 months. Fine main-
tained cosmetically acceptale regrowth without %urther =$,$
%or an average o% /3.. months8 a %urther 3 with continued treat-
ment "mean %ollow-up -0.: months#. Aowever! 3 had poor re-
growth despite continued treatment! and the last 0 discontinued
treatment as the result o% side e%%ects.
;.
Similar regrowth and
relapse rates have een %ound in children ";--;;6 improvement
a%ter : months#.
;3!<2
$oor prognostic %actors %or response to
=$,$ include disease severity and duration! age o% onset!
%amily history! nail changes! and atopy.
;:!;.
$hotochemotherapy "$)*A#
There are many uncontrolled studies o% $)*A treatment in a range
o% modalities "local! whole ody! and oral or topical psoralen#
claim- ing response rates o% up to :26.
</-<;
Aowever! two
retrospective reviews o% clinical e+perience suggested that the
response rate is low ":.;-/;./6 a%ter at least ; months treatment#
<<
or was no etter than spontaneous improvement.
<0
Mino+idil
Most clinical trials o% topical mino+idil lotion have %ailed to show
a signi%icant treatment response.
<:-<.
Ene study o% e+tensive AA!
in which ;6 mino+idil lotion was used under petrolatum
occlusion! hair regrowth occurred more %re&uently in patients
receiving active treatment than in control su9ects.
<3
Aowever! the
numer o% pa- tients treated was small and the e+perience o% most
clinicians is that topical mino+idil is o% little value in AA.
=ithranol
There have een a small numer o% uncontrolled case series
evalu- ating dithranol "anthralin# in the treatment o% AA.
02-0-
The
largest treated :. patients with dithranol! 2.0-/.26. Twenty-%ive
percent responded! although only /5.:6 maintained a good
cosmetic re- sponse. The mean time to cosmetic response was -;
wee4s.
0/
Miscellaneous
,yclosporin appears to stimulate hair growth in some patients with
AA!
0;
ut the results are not good enough to 9usti%y the ris4s.
0<
$ulished case series have also reported responses to sul%asala-
(ine
00!0:
and methotre+ate!
05
ut these need to e con%irmed in
controlled trials. Ine%%ective treatments include topical tacrolimus!
0.
mycophenolate mo%etil!
03
and photodynamic therapy.
:2!:/
Biological =rugs
Initial optimism that iological drugs would introduce a new era in
the treatment o% AA has so %ar not een reali(ed. The anti-tumor
necrosis %actor drugs appear ine%%ective. There are case reports o%
worsening or onset o% AA during treatment with in%li+ima
:--:<
and
a series o% /5 patients showed no response to etanercept.
:0
In a
randomi(ed controlled trial o% :- patients the anti-,=//a
iological e%ali(uma also was ine%%ective.
::
A case report o%
alopecia univer- salis responding to ale%acept needs to e
con%irmed in a larger study.
:5
Conclusions
Although many treatments e+ist %or AA! none alters the natural
history o% the disease! and assessment o% each treatment is
di%%icult ecause o% a lac4 o% controlled trials and the occurrence
o% sponta- neous remission. Most studies are short term! lasting
less than :
Alopecia areata 17
months! and those that last longer show poor long-term ene%it
%rom the interventions. ,ontact immunotherapy is the est-docu-
mented treatment %or severe AA! including e+tensive patchy loss!
alopecia totalis and universalis. Aowever! a relatively small propor-
tion o% patients achieve good long-term cosmetic results! and con-
tact immunotherapy is not licensed or widely availale. $otent
top- ical steroids or intralesional steroids %orm the mainstay o%
treatment %or limited disease ut are o% little value in rapidly
progressive alo- pecia or alopecia totalisGuniversalis.
The ,ochrane review highlighted the paucity o% good-&uality
controlled trials in AA and also noted the asence o% patient
assess- ments o% the outcomes.
//
In most patients with e+tensive
AA! hair loss is a li%elong a%%lictionLin a long-term %ollow-up
study o% /3/ patients seen with AA etween /3.;-/332! almost all
those present- ing with alopecia totalisGuniversalis still had severe
disease and only aout hal% o% those presenting with patchy
alopecia were disease- %ree.
:.
,onse&uently! management aimed at
helping patients cope with their lac4 o% hair is proaly o% greater
importance than med- ical treatment. Such measures are
inherently di%%icult to evaluate ecause they depend on doctor?
patient relationships that cannot e easily standardi(ed.
Fevertheless! until more e%%ective therapies e- come availale!
clinical research in AA should perhaps place greater emphasis on
the value o% areas such as counselling services! pros- thetic
support! and sel%-help groups than has een the case to date.
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<-. Mitchell AB! =ouglass M,: Topical photochemotherapy %or alopecia areata. B Am
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<<. Taylor ,@! Aaw4 BI: $)*A treatment o% alopecia areata partialis! totalis and
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<:. Tosti A! =e $adova M$! Minghetti G! et al: Therapies versus placeo in the treatment
o% patchy alopecia areata. B Am Acad =ermatol /0:-23--/2! /3.:
<5. *estey B$! Savin BA: A trial o% /6 mino+idil used topically %or severe alopecia
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<.. Cransway AC! Muller SA: ; percent topical mino+idil compared with placeo %or
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0/. Ciedler-'eiss *,! Buys ,M: Evaluation o% anthralin in the treatment o% alopecia
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0-. Schmoec4el ,! 'eissmann I! $lewig G! et al: Treatment o% alopecia areata y
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05. Boly $: The use o% methotre+ate alone or in comination with low doses o% oral
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/3/ patients. B Am Acad =ermatol 00:<;.-<</! -22:
Alopecia areata adalah suatu 4ondisi umum yang menyea4an ramut ronto4
nonscarring . Mung4in tamal sulam ! meliat4an seluruh 4ulit 4epala " alopecia
totalis # atau seluruh tuuh " alopecia universalis # . $asien mung4in semuh
spontan namun gangguan terseut dapat mengi4uti 4ursus 4amuh erulang atau
menyea4an ramut ronto4 terus-menerus . Alopecia areata dapat menyea4an
te4anan psi4ologis yang esar ! dan aspe4 yang paling penting dari mana9emen
4onseling pasien tentang si%at ta4 terduga dan tentu sa9a 4ondisi serta pengoatan
yang e%e4ti% yang tersedia ! dengan rincian e%e4 samping mere4a . Mes4ipun
anya4 perawatan telah teru4ti untu4 merangsang pertumuhan ramut di
alopecia areata ! ada data teratas tentang 4eman9uran 9ang4a pan9ang dan
erdampa4 pada 4ualitas hidup . 7ami menin9au u4ti untu4 perawatan eri4ut
umum diguna4an : 4orti4osteroid " topi4al ! intralesi ! dan sistemi4 # ! sensiti(er
topi4al " diphenylcyclopropenone # ! $SE@ - alen dan %ototerapi ultraviolet A
" $)*A # ! mino+idil dan ditranol .
Semin ,utan Med Surg -.:/0-/. 1 -223 Elsevier Inc All rights reserved .

lopecia areata " AA # adalah nonscarring ramut ronto4 caus - ing 4ondisi
peradangan 4ronis . @esi4o seumur hidup mengemang4an 4ondisi telah
diper4ira4an /!5 6 dan menyumang / 6 sampai - 6 dari pasien aru terlihat di
4lini4 dermatologi di Inggris dan Ameri4a States./ onset dapat ter9adi pada semua
usia ! namun ! mayoritas " :2 6 # dimulai seelum -2 tahun age.- Ada pemerataan
4e9adian di seluruh ras dan 9enis 4elamin . =alam eerapa de4ade tera4hir ! peran
predile4si geneti4 telah mulai di9elas4an . 7ira-4ira -4ira -2 6 dari orang yang
18 S. Garg and A.G. Messenger ter4ena memili4i riwayat 4eluarga penya4it ! menun9u44an predisposition.;
geneti4 Seuah studi 4emar 4ecil yang ditemu4an 4omponen diwaris4an pada
se4itar 00 6 dari mere4a yang menderita 4arena penya4it ini ! menun9u44an ada
9uga 4ontriusi dari %a4tor ling4ungan .< Asosiasi telah dilapor4an dengan
4romosom -/ " di-er4erut insiden sindrom =own # ! ma9or histocompatiility
comple+ ! dan sito4in dan immunogloulin gen menun9u44an secara poligeni4 .
Scan lo4us tamahan genome mengidenti%i4asi ahwa
9uga yang terliat dalam gangguan ramut lain dan psoriasis.0
AA dianggap seagai 4ondisi autoimun 9aringan - teratas seagai hasil dari
huungan dengan penya4it autoimun lainnya ! ai4 di dalam orang yang ter4ena
dan 4eluarga mere4a . Beredar antiodi terhadap 4omponen %oli4el terdete4si
leih sering pada orang dengan AA.: ! 5 Seuah tanda dari AA adalah in%iltrat
lim%ositi4 periular yang terutama terdiri dari dia4ti%4an $ercoaan T -
lymphocytes.. mengguna4an %oli4el ramut manusia ditransplantasi4an 4e ti4us
immunoincompetent 4uat meliat4an T -a diperantarai sel pathomechanism.3
Erang yang ter4ena mengemang4an halus ! patch ai4 - sir4um 9elas4an tunggal
atau multi%ocal dengan ramut rusa4 pende4 di pinggiran " tanda seru ramut # .
$ola dan ting4at 4eparahan ramut ronto4 ervariasi . Semua 4ulit yang
ditumuhi ramut mung4in terliat ! dengan se4itar /2 6 dari mere4a yang
=epartemen =ermatology ! @umah Sa4it Aallamshire @oyal! She%%ield ! Inggris
7ingdom.
Alamat 4orespondensi : AG Messenger ! =epartemen =ermatology ! @umah Sa4it
@oyal Aallamshire ! Glossop @oad! She%%ield S/2 -BC ! Inggris . E - mail:
a.g.messenger D
dengan AA memili4i 4eterliatan 4u4u . $emulihan dapat ter9adi secara spontan !
mes4ipun ramut ronto4 dapat 4amuh dan 4ema9uan untu4 alopecia totalis " total
loss dari 4ulit 4epala ramut# atau universalis " ai4 tuuh dan 4ulit 4epala
ramut# . =iagnosis adalah usu - se4utu diuat secara 4linis ! dan investigasi
iasanya tida4 diperlu4an . $rognosis uru4 ini ter4ait dengan adanya penya4it
4e4ealan tuuh lainnya ! riwayat 4eluarga AA ! usia muda saat onset ! distro%i
4u4u ! ramut ronto4 luas ! dan ophiasis " AA dari margin 4ulit 4epala # ./2
AA dapat menyea4an masalah psi4ologis yang signi%i4an . Si%at tida4 isa
diper4ira4an dari 4ondisi ! dengan perai4an yang 9elas dii4uti dengan 4erusa4an
dapat menyedih4an . Salah satu yang paling penting 4arena prospe4nya dari
mana9emen 4onseling pasien dan 4eluarga para anggota dari ana4 muda tentang
si%at dan tentu sa9a 4ondisi serta pengoatan yang e%e4ti% yang tersedia dengan
rincian dari apa yang mere4a meliat4an dan e%e4 sampingnya .
pengoatan
The %oli4el ramut di AA tida4 hancur . Eleh 4arena itu! ada potensi untu4
tumuh 4emali ! mes4ipun tida4 ada oat dan tida4 ada pengoatan telah
ditun9u44an untu4 menguah per9alanan penya4it . Banya4 pengoatan dapat
menyea4an pertumuhan ramut . Famun! menilai 4eerhasilan sulit di AA
merata seagai a4iat dari %re4uensi pemulihan spontan . =i sisi lain ! studi
menggaung4an pasien dengan penya4it erat yang terhamat oleh respon yang
uru4 terhadap segala entu4 pengoatan pada 4elompo4 pasien ini .
Ada eerapa percoaan ter4ontrol aca4 dari pengoatan untu4 AA ! // mes4ipun
untu4 modalitas pengoatan umum tida4 ada telah menun9u44an man%aat 9ang4a
pan9ang yang signi%i4an dianding4an dengan plaseo . Ada anya4 laporan dari
pengoatan untu4 AA yang telah dinilai e%i4asi dengan 4riteria yang 4urang ideal.
Banya4 dari studi ini dan laporan adalah nilai diragu4an ! namun ! eerapa
perawatan yang elum dievaluasi dalam percoaan ter4ontrol aca4 mung4in
erman%aat agi eerapa pasien .
ida4 ada $engoatan
7arena ada proporsi yang tinggi pemulihan spontan ! dengan ;< 6
02 6 pulih dalam wa4tu / tahun ! /- tida4 semua pasien memerlu4an perawatan .

/2.0-0:-3G23 G H - lihat hal depan 1 -223 Elsevier Inc All rights reserved . /0
doi : /2./2/:G9.sder.-22../-.22-


Famun! si%at 4amuh penya4it perlu didis4usi4an dengan pasien . $asien dengan
AA iasanya ermotivasi tinggi dan 4ompli4asi - semut ! namun eerapa pasien
mung4in tida4 ingin pengoatan atau mung4in tida4 merespon dan alternati%
seperti wig ! 9uga harus diahas.
4orti4osteroid
Topical 7orti4osteroid
Steroid topi4al yang poten secara luas diguna4an untu4 mengoati AA ! namun
u4ti untu4 4eerhasilan mere4a teratas . A /- - minggu dalam-pasien studi " sisi
4anan vs 4iri 4ulit 4epala # pada penya4it sedang sampai erat dengan clo -
etasol %ormulasi usa propionat 2!20 6 menun9u44an pertumuhan 4emali
setida4nya
02 6 dalam 5 dari ;< situs yang dioati dianding4an dengan / dari ;< di sites./;
nontreated Seuah studi seelumnya 2!20 6 cloetasol propionat awah o4lusi
pada pasien dengan alopecia universalis G totalis menun9u44an ahwa -3 6 " n . #
diuntung4an ! namun ; pasien ! 4amuh dalam
: ulan %ollow -up! memeri4an 4eseluruhan ene%it./< 9ang4a pan9ang /5!. 6
=alam
penelitian secara aca4 memanding4an etametason valerat usa untu4 eta -
methasone dipropionate lotion pada :/ pasien dengan ringan sampai moder -
ma4an AA ! %ormulasi usa yang dihasil4an secara signi%i4an leih esar
pertumuhan 4emali pada /- wee4s./0 Famun ! seuah studi oleh
,haruwichitratana et al/: dari 2!-0 6 deso+imetasone 4rim di alopecia moderat
gagal menun9u44an man%aat yang signi%i4an atas plaseo setelah /- minggu
pengoatan . ida4 ada $engoatan
7arena ada proporsi yang tinggi pemulihan spontan ! dengan ;< 6
02 6 pulih dalam wa4tu / tahun ! /- tida4 semua pasien memerlu4an perawatan .

/2.0-0:-3G23 G H - lihat hal depan 1 -223 Elsevier Inc All rights reserved . /0
doi : /2./2/:G9.sder.-22../-.22-


Famun! si%at 4amuh penya4it perlu didis4usi4an dengan pasien . $asien dengan
AA iasanya ermotivasi tinggi dan 4ompli4asi - semut ! namun eerapa pasien
mung4in tida4 ingin pengoatan atau mung4in tida4 merespon dan alternati%
seperti wig ! 9uga harus diahas.
4orti4osteroid
Topical 7orti4osteroid
Steroid topi4al yang poten secara luas diguna4an untu4 mengoati AA ! namun
u4ti untu4 4eerhasilan mere4a teratas . A /- - minggu dalam-pasien studi " sisi
4anan vs 4iri 4ulit 4epala # pada penya4it sedang sampai erat dengan clo -
etasol %ormulasi usa propionat 2!20 6 menun9u44an pertumuhan 4emali
setida4nya
02 6 dalam 5 dari ;< situs yang dioati dianding4an dengan / dari ;< di sites./;
nontreated Seuah studi seelumnya 2!20 6 cloetasol propionat awah o4lusi
pada pasien dengan alopecia universalis G totalis menun9u44an ahwa -3 6 " n . #
diuntung4an ! namun ; pasien ! 4amuh dalam
: ulan %ollow -up! memeri4an 4eseluruhan ene%it./< 9ang4a pan9ang /5!. 6
=alam
penelitian secara aca4 memanding4an etametason valerat usa untu4 eta -
methasone dipropionate lotion pada :/ pasien dengan ringan sampai moder -
ma4an AA ! %ormulasi usa yang dihasil4an secara signi%i4an leih esar
pertumuhan 4emali pada /- wee4s./0 Famun ! seuah studi oleh
,haruwichitratana et al/: dari 2!-0 6 deso+imetasone 4rim di alopecia moderat
gagal menun9u44an man%aat yang signi%i4an atas plaseo setelah /- minggu
pengoatan . @e9imen termasu4 prednisolon ! - g intravena dosis tunggal atau 2!0
g sehari selama 0 hari ! -- ola4 dosis harian ! -/ meruncing dosis oral selama :
minggu ! -; intravena metilprednisolon -02 mg dua 4ali sehari selama ; days-<
dan ;22 mg ulanan untu4 setida4nya < months.-0 7eanya4an penelitian telah
melapor4an respon awal yang ai4 untu4 terapi ! mulai dari //!< 6 men9adi <5
6 . Bagaimana - pernah ! man%aat hanya dipertahan4an sementara pasien terus
memperla4u4an -

ment . Seuah u9i coa ter4ontrol secara aca4 menun9u44an pasien yang
menerima -22 mg prednisolon se4ali seminggu selama ; ulan leih mung4in
untu4 mengemang4an pertumuhan 4emali yang signi%i4an ! dianding4an
mere4a yang dieri4an plaseo . Bagaimana - pernah ! -0 6 4amuh dalam wa4tu
; ulan dari penghentian memperla4u4an - ment.-: =ua penelitian lain
menemu4an ! setelah respon awal ! ahwa : ulan sampai /0 ulan setelah
pengoatan tida4 ada en - e%it.-/ sustansial ! -- $ercoaan leih lan9ut
menun9u44an - 6 mino+idil lotion setelah : minggu meruncing prednisolon dapat
menurun4an ramut loss.-; 4orti4osteroid $ulsed tampa4nya dapat ditoleransi
dengan ai4 . Famun! mere4a re(im lisan receiver - ing setiap hari atau hari
alternati% di4emang4an e%e4 samping yang diharap4an ! termasu4 : 9erawat !
oesitas ! hipertensi ringan ! gangguan cadangan A,TA ! dan lenticular
opacities.-/ steroid oral muncul untu4 e4er9a dengan ai4 pada awalnya pada
penya4it aru - onset ! tetapi ophiasis dan universal salis merespon poorly.-<
4onta4 Imunoterapi
Auungi imunoterapi dide%inisi4an seagai indu4si dan elisitasi periodi4 dari
dermatitis 4onta4 alergi oleh apli4asi topi4al dari alergen 4onta4 4uat . Sensiti(er
topi4al telah men9adi andalan pengoatan di AA parah se9a4 /35: 4eti4a
dinitrochloroen(ene " =F,B # pertama 4ali diguna4an . Seagai hasil dari
4e4hawatiran atas si%at mutageni4 dari =F,B di Salmonella typhimurium
enteritides serotipe dan penyerapan melalui 4ulit dengan e4s4resi utama dalam
urin ! penggunaannya telah dihenti4an . Asam s&uaric diutylester " SA=BE #
9uga telah diguna4an 4arena tida4 mutageni4 dalam tes Salmonella microsome .
Famun! mahal dan tida4 stail dalam aseton seagai diphenylcyclopropenone
" =$,$ # . =$,$ ! pertama 4ali diper4enal4an oleh Aapple ! -5 telah men9adi
sensiti(er topi4al pilihan . Ini menun9u44an tida4 ada si%at mutageni4 di