Alopecia areata with limited hair loss of recent onset
For alopecia areata with limited hair loss of recent onset, apply a potent or very potent topical corticosteroid for at least 3 to 4 months. Response to treatment is judged by whether new growth appears after a few weeks. Use:
1betamethasone dipropionate 0.05% lotion topically, once or twice daily for 3 to 4 months1 betamethasone dipropionate betamethasone dipropionate betamethasone dipropionate
OR
1mometasone furoate 0.1% lotion topically, once or twice daily for 3 to 4 months. mometasone furoate mometasone furoate mometasone furoate
If there is no response to topical therapy after 3 to 4 months, consider intralesional corticosteroid injections (eg triamcinolone 5mg/mL) every 6 to 8 weeks. A few treatment sessions may be required to achieve full regrowth. Advise the patient that the injections can cause headaches (anytime within 24 hours of having injections) and skin atrophy.
Alternatively, refer patients who do not respond, or who have new or expanding patches, to a dermatologist for advice. Specialist therapy includes intralesional and systemic corticosteroids, diphencyprone (DCP) immunotherapy, oral minoxidil and immunosuppression.
Alopecia areata that involves the eyebrows and eyelashes is difficult to treat. For eyebrow alopecia areata, a moderately potent topical corticosteroid can be trialled, while awaiting dermatology review. Use:
methylprednisolone aceponate (adult, or child 4 months or older) 0.1% cream or lotion topically, once or twice daily for 3 to 4 months. methylprednisolone aceponate methylprednisolone aceponate methylprednisolone aceponate