Alopecia areata with extensive hair loss

If topical therapy for limited hair loss is not successful, or if the hair loss is extensive, management options are to:

• refer to a dermatologist for specialist treatments such as diphencyprone (DCP) immunotherapy, oral corticosteroids or immunosuppression. Treatment for extensive alopecia areata should be started quickly, particularly if onset has been rapid; consider discussing the patient with a dermatologist to avoid long wait times
• discuss acceptance, and offer psychological counselling and camouflage options (eg a wig).

A wig can be worn if the hair is unlikely to regrow or the patient wants to disguise the hair loss. Wig subsidies are available through the Australia Alopecia Areata Foundation (AAAF) and some state health departments.

At the time of writing, phase II and III clinical trials of oral Janus kinase (JAK) inhibitors for treatment of moderate to severe alopecia areata are in progress, and results are promising. This class of drugs (eg baricitinib, tofacitinib) is not currently registered for use in Australia for alopecia areata.