Guideline sources The following summarized guidelines for the management of alopecia areata are prepared by our editorial team based on guidelines from the British Photodermatology Group (BPG/BAD 2019), the British Association of Dermatologists (BAD 2012), and the American Association of Family Physicians (AAFP 2009). 1 2 3 Guidelines 1. Medical management Topical therapy: As per BAD 2012 guidelines: Offer potent topical corticosteroids in patients with limited alopecia areata. B Recognize that other topical treatment options include minoxidil B and dithranol. B As per AAFP 2009 guidelines, offer topical corticosteroids applied BID in patients with alopecia areata. B Show 3 more Contact immunotherapy: As per BAD 2012 guidelines, offer contact immunotherapy in patients with extensive alopecia areata or alopecia totalis/universalis. B https://web.pathway.md/diseases/recCA3d9B062j9g6j 1/3 6/23/23, 2:18 AM Alopecia areata Pathway As per AAFP 2009 guidelines, offer topical immunotherapy with diphenylcyclopropenone or squaric acid applied by dermatologist every few weeks in patients with alopecia areata. B Systemic therapy: As per BAD 2012 guidelines, recognize that the following systemic agents have limited roles in the management of patients with alopecia areata: systemic corticosteroids B calcineurin inhibitors B sulfasalazine B methotrexate B isoprinosine B biologic agents. B As per AAFP 2009 guidelines: Offer a 6-week tapering course of oral prednisone starting at 40 mg/day in patients with alopecia areata. B Recognize that oral corticosteroids and cyclosporine have no long-term benefits in patients with alopecia areata. A 2. Nonpharmacologic interventions Wig and hairpiece: Offer wig/hairpiece use in patients with extensive alopecia areata. B Offer wig use in patients with alopecia totalis/universalis. B Alternative and complementary therapies: recognize that aromatherapy and hypnotherapy have limited roles in the management of patients with alopecia areata. B 3. Therapeutic procedures Intralesional corticosteroids: As per BAD 2012 guidelines, consider performing intralesional corticosteroid injections in patients with limited alopecia areata. C As per AAFP 2009 guidelines, consider performing intralesional injections of triamcinolone acetonide 5-10 mg/mL; 0.1 mL injected with a 30-gauge needle into the dermis 1 cm apart to a maximum of 3 mL. Consider repeating every 4-6 weeks. C Phototherapy: As per BPG 2019 guidelines, insufficient evidence to support the use of photodynamic therapy in patients with alopecia areata. I As per BAD 2012 guidelines, recognize that psoralen-UV A therapy has a limited role in the management of patients with alopecia areata. B https://web.pathway.md/diseases/recCA3d9B062j9g6j 2/3 6/23/23, 2:18 AM Alopecia areata Pathway As per AAFP 2009 guidelines, recognize that photodynamic therapy has no long-term benefits in patients with alopecia areata. A Laser therapy: recognize that laser therapy has a limited role in the management of patients with alopecia areata. B 4. Specific circumstances Eyelash alopecia: recognize that prostaglandin F2-alpha analogs (latanoprost and bimatoprost) have limited roles in the management of patients with eyelash alopecia. B References 1. A G Messenger, J McKillop, P Farrant et al. British Association of Dermatologists' guidelines for the management of alopecia areata 2012. Br J Dermatol. 2012 May;166 5 916 26. Open 2. Anne L Mounsey, Sean W Reed. Diagnosing and treating hair loss. Am Fam Physician. 2009 Aug 15;80 4 356 62. Open 3. T H Wong, C A Morton, N Collier et al. British Association of Dermatologists and British Photodermatology Group guidelines for topical photodynamic therapy 2018. Br J Dermatol. 2019 Apr;180 4 730 739. Open 4. Messenger AG, McKillop J, Farrant P et al. British Association of Dermatologists' guidelines for the management of alopecia areata 2012. Br J Dermatol. 2012 May;166 5 916 26. Open 5. Brett King, Manabu Ohyama, Ohsang Kwon et al. Two Phase 3 Trials of Baricitinib for Alopecia Areata. N Engl J Med. 2022 May 5;386 18 1687 1699. Open 6. Brett King, Manabu Ohyama, Ohsang Kwon et al. Two Phase 3 Trials of Baricitinib for Alopecia Areata. N Engl J Med. 2022 May 5;386 18 1687 1699. Open https://web.pathway.md/diseases/recCA3d9B062j9g6j 3/3