How to Diagnose and Manage Alopecia Areata

During an afternoon session at the 2022 Fall Clinical Dermatology Conference in Las Vegas, Nevada, Dr. Brett King, Associate Professor of Dermatology at 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 for diagnosing patients with alopecia areata (AA) and how new therapies can be integrated into clinical practice.

AA is an autoimmune disease characterized by rapid onset hair loss on the scalp, eyebrows, eyelashes, and in some severe cases, body involvement. AA can be associated with an unpredictable prognosis, with relapses, remissions, and persistent hair loss. Typically, AA is more common in children, but it affects both sexes and all ethnicities equally.

Clinical presentations of AA include:

  • Patchy hair loss
  • Total alopecia
  • Alopecia universalis
  • ophiasis pattern
  • Inverse Ophiasis (or Sisaipho) pattern
  • diffuse pattern
  • Alopecia barbae
  • Alopecia areata of the nails

To accurately diagnose AA, dermatologists should perform a history, physical exam, dermatoscopy, hair pulling test, and biopsy. Another tool to use is the Alopecia Areta Investigator Globa Assessment (AA-IGA), which assesses the severity of the condition based on the extent of hair loss on the scalp.

According to the speakers, there are several factors to consider when choosing a treatment option for children and adults with AA, such as:

  • age of the patient
  • location of hair loss
  • extent of disease
  • severity of the disease
  • presence of other diseases
  • Scalp biopsy report on the hair cycle and inflammation
  • Patient/parent choice after a thorough review of the proposed treatment and its risks, benefits and expectations
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For patchy AA, the 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 are also showing positive results in the effective treatment of 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 the context of AA treatment in adolescents and adults.

In concluding their presentation, King, Callender and Hordinsky emphasized that there are different clinical manifestations of AA, ranging from patchy areas of hair loss to full scale scalp and body hair loss. Current treatments include topical, intralesional, and systemic interventions. However, these treatments show varying degrees of success.


King B, Callender V, Hordinsky M. The guide to the diagnosis and treatment of alopecia areata. Clinical Dermatology Fall 2022 Conference. October 21, 2022. Las Vegas, Nevada.

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