Diagnosis and treatment
Fungal infections should be excluded especially when the lesion is slightly atypical (when scaling is present) (1).
Active hair shedding can be demonstrated by the "pull test" - grasping and pulling around 60 hairs from the periphery of the lesion between the finger and thumb. If 2-10 hairs are obtained the test is positive (1) Treatment options depend on the extent of hair loss and the patients' preference (1).
Treatment of non-extensive alopecia areata (less than 50% hair loss) includes:
- Watchful waiting - the condition is self-limiting so the best plan is to reassure the patient and to encourage patience since spontaneous regrowth may not be visible for up to 3 months. A placebo is often useful eg. a short course of UVB. If treatment is preferred by the patient
- Referral to a dermatologist for the use of intralesional corticosteroids (ILCs) - ILCs is the most effective treatment options for patients with non-extensive alopecia areata
- topical corticosteroids and topical minoxidil - can be used on patients (over 16 years of age) who are waiting for a dermatologist referral or on patients who want treatment in primary care only
- Psychological counseling (1)
Treatment of extensive alopecia areata (more than 50% hair loss) includes:
- Watchful waiting - spontaneous remission may occur, but is less likely than non-extensive alopecia areata
- Early dermatological referral for treatment with topical immunotherapies (eg, contact sensitizers such as diphencyprone or squaric acid dibutylester), topical minoxidil, and cyclosporin
- however, for many patients, therapy is limited by poor efficacy and/or problems with toxicity ¢ topical corticosteroids and topical minoxidil - can be considered for patients who are waiting for dermatologist referral or for patients who wants treatment in primary care only
- Psychological counseling
- A wig is indicated for more severe and extensive hair loss (1).
Study evidence revealed that efalizumab was not effective in promoting hair regrowth in a small cohort of patients with moderate-to-severe alopecia areata (2).
Reference: