At the 2022 Fall Clinical Dermatology Conference, 3 expert clinicians share their strategies for diagnosing and managing alopecia areata.
During an afternoon session at the 2022 Fall Clinical Dermatology Conference in Las Vegas, Nevada, Brett King, MD, PhD, associate professor of dermatology at the Yale School of Medicine, Valerie D. Callender, MD, founder and medical director of the Callender Dermatology & Cosmetic Center, and Maria K. Hordinsky, MD, professor and chair of the department of dermatology at the University of Minnesota, presented their strategies on diagnosing patients with alopecia areata (AA) and how to incorporate novel therapies into clinical practice.
AA is an autoimmune condition characterized by a rapid onset hair loss on the scalp, eyebrows, eyelashes, and in some severe cases, body involvement. AA can come with an unpredictable prognosis, with relapses, remissions, and persistent hair loss. Typically, AA is more prevalent in children, but it affects both sexes and all ethnicities equally.
Clinical presentations of AA include:
To accurately diagnose AA, dermatologists should complete a medical history review, physical exam, dermoscopy, hair pull test, and a biopsy. Another tool to use is the Alopecia Areta Investigator Globa Assessment (AA-IGA), which examines disease severity by the amount of scalp hair loss.
According to the speakers, there are multiple factors to consider when choosing a treatment option for children and adults with AA, such as:
For patchy AA, suggested treatments are topical or intralesional corticosteroids, minoxidil solution, anthralin, steroids in shampoo formulations, and topical immunotherapy. Treatment options for extensive AA include topical corticosteroids, topical minoxidil, topical immunotherapy, dithranol, oral vitamin D, phototherapy, laser therapy, and biologics.
Janus Kinase (JAK) inhibitors also show positive results for effectively managing AA. Oral ruxolitnib has been shown to induce hair regrowth in patients with moderate-to-severe AA. Tofacitinib is another JAK inhibitor that has been studied in relation to AA treatment for adolescents and adults.
To conclude their presentation, King, Callender, and Hordinsky stressed that there are various clinical presentations of AA ranging from patchy areas of hair loss to complete scalp involvement and body hair loss. Current treatments include topical, intralesional, and systemic interventions. However, these treatments demonstrate varying degrees of success.
King B, Callender V, Hordinsky M. The ‘how-to’ on diagnosing and managing alopecia areata. 2022 Fall Clinical Dermatology Conference. October 21, 2022. Las Vegas, Nevada.