British Association of Dermatologists' guidelines for the management of alopecia areata 2012

British Journal of Dermatology

Volumn 166, Issue 5, 2012, Pages 916-926

  Messenger, A G ^a   McKillop, J ^b   Farrant, P ^c   McDonagh, A J ^a   Sladden, M ^d  

^a ROYAL HALLAMSHIRE HOSPITAL   (United Kingdom)

^b Alopecia UK   (United Kingdom)

^c BRIGHTON GENERAL HOSPITAL   (United Kingdom)

^d UNIVERSITY OF TASMANIA   (Australia)

Author keywords

[No Author keywords available]

Indexed keywords

1 CHLORO,2,4,DINITROBENZENE; 2,3 DIPHENYLCYCLOPROPENONE; ALEFACEPT; BENZENE DERIVATIVE; BIMATOPROST; CLOBETASOL; CLOBETASOL PROPIONATE; CYCLOSPORIN A; DESOXIMETASONE; DEXAMETHASONE; DITHRANOL; ESTER DERIVATIVE; HYDROCORTISONE ACETATE; KETONE DERIVATIVE; LATANOPROST; METHISOPRINOL; METHOTREXATE; METHYLPREDNISOLONE; MINOXIDIL; PLACEBO; PREDNISOLONE; PSORALEN; SALAZOSULFAPYRIDINE; SQUARIC ACID DIBUTYLESTER; TACROLIMUS; TRIAMCINOLONE; TRIAMCINOLONE ACETONIDE; TRIAMCINOLONE HEXACETONIDE; UNCLASSIFIED DRUG;

ALOPECIA AREATA; AROMATHERAPY; ARTICLE; ASSOCIATION; BRITISH ASIAN; CERVICAL LYMPHADENOPATHY; DERMATITIS; DERMATOLOGIST; DOUBLE BLIND PROCEDURE; DRUG MEGADOSE; FOLLICULITIS; HUMAN; HYPERPIGMENTATION; HYPERTRICHOSIS; HYPOPIGMENTATION; IMMUNOTHERAPY; LOW LEVEL LASER THERAPY; OPEN ANGLE GLAUCOMA; PRACTICE GUIDELINE; PRIORITY JOURNAL; PROSTHESIS; RANDOMIZED CONTROLLED TRIAL (TOPIC); SKIN ATROPHY; ULTRAVIOLET A RADIATION; URTICARIA; VITILIGO;

ALOPECIA AREATA; AROMATHERAPY; DERMATOLOGIC AGENTS; HUMANS; HYPNOSIS; IMMUNOTHERAPY; LASER THERAPY; PROSTHESES AND IMPLANTS;

EID: 84860346016     PISSN: 00070963     EISSN: 13652133     Source Type: Journal    
DOI: 10.1111/j.1365-2133.2012.10955.x     Document Type: Article

References (92)

1. Bell HK, Ormerod AD,. Writing a British Association of Dermatologists' clinical guideline: an update on the process and guidance for authors. Br J Dermatol 2009; 160: 725-8.
2. The AGREE Collaboration. Appraisal of Guidelines Research and Evaluation (AGREE) Instrument. Available at: (last accessed 6 March 2012).
3. Ikeda T,. A new classification of alopecia areata. Dermatologica 1965; 131: 421-45.
4. Walker SA, Rothman S,. Alopecia areata: a statistical study and consideration of endocrine influences. J Invest Dermatol 1950; 14: 403-13.
5. Gip L, Lodin A, Molin L,. Alopecia areata. A follow-up investigation of outpatient material. Acta Derm Venereol 1969; 49: 180-8.
6. Tosti A, Bellavista S, Iorizzo M,. Alopecia areata: a long term follow-up study of 191 patients. J Am Acad Dermatol 2006; 55: 438-41. (Pubitemid 44189598)
7. Anderson I,. Alopecia areata: a clinical study. Br Med J 1950; 2: 1250-2.
8. Muller SA, Winkelmann RK,. Alopecia areata. Arch Dermatol 1963; 88: 290-7.
9. De Waard-van der Spek FB, Oranje AP, De Raeymaecker DM, et al. Juvenile versus maturity-onset alopecia areata-a comparative retrospective clinical study. Clin Exp Dermatol 1989; 14: 429-33. (Pubitemid 19278989)
10. Sharma VK, Dawn G, Kumar B,. Profile of alopecia areata in Northern India. Int J Dermatol 1996; 35: 22-7. (Pubitemid 26034119)
11. McDonagh AJG, Messenger AG,. The pathogenesis of alopecia areata. Dermatol Clin 1996; 14: 661-70. (Pubitemid 26322534)
12. Petukhova L, Duvic M, Hordinsky M, et al. Genome-wide association study in alopecia areata implicates both innate and adaptive immunity. Nature 2010; 466: 113-17.
13. Gilhar A, Ullmann Y, Berkutzki T, et al. Autoimmune hair loss (alopecia areata) transferred by T lymphocytes to human scalp explants on SCID mice. J Clin Invest 1998; 101: 62-7. (Pubitemid 28058903)
14. Paus R, Ito N, Takigawa M, et al. The hair follicle and immune privilege. J Investig Dermatol Symp Proc 2003; 8: 188-94. (Pubitemid 37222828)
15. Kang H, Wu WY, Lo BK, et al. Hair follicles from alopecia areata patients exhibit alterations in immune privilege-associated gene expression in advance of hair loss. J Invest Dermatol 2010; 130: 2677-80.
16. Tosti A,. Dermoscopy of Hair and Scalp Disorders: with Clinical and Pathological Correlations. London: Informa Healthcare, 2007.
17. White MI, Currie J, Williams MP,. A study of the tissue iron status of patients with alopecia areata. Br J Dermatol 1994; 130: 261-3. (Pubitemid 24204632)
18. Boffa MJ, Wood P, Griffiths CE,. Iron status of patients with alopecia areata. Br J Dermatol 1995; 132: 662-4.
19. Esfandiarpour I, Farajzadeh S, Abbaszadeh M,. Evaluation of serum iron and ferritin levels in alopecia areata. Dermatol Online J 2008; 14: 21.
20. Hunt N, McHale S,. The psychological impact of alopecia. BMJ 2005; 331: 951-3. (Pubitemid 41510855)
21. Changing Faces. Face Equality for Patients with Disfiguring Conditions: How Health and Social Care Professionals Can Support and Empower. London: Changing Faces, 2009.
22. Delamere FM, Sladden MM, Dobbins HM, et al. Interventions for alopecia areata. Cochrane Database Syst Rev 2008; 2: CD004413.
23. Charuwichitratana S, Wattanakrai P, Tanrattanakorn S,. Randomized double-blind placebo-controlled trial in the treatment of alopecia areata with 0·25% desoximetasone cream. Arch Dermatol 2000; 136: 1276-7.
24. Tosti A, Iorizzo M, Botta GL, et al. Efficacy and safety of a new clobetasol propionate 0·05% foam in alopecia areata: a randomized, double-blind placebo-controlled trial. J Eur Acad Dermatol Venereol 2006; 20: 1243-7. (Pubitemid 44614622)
25. Tosti A, Piraccini BM, Pazzaglia M, et al. Clobetasol propionate 0.05% under occlusion in the treatment of alopecia totalis/universalis. J Am Acad Dermatol 2003; 49: 96-8. (Pubitemid 36801639)
26. Porter D, Burton JL,. A comparison of intra-lesional triamcinolone hexacetonide and triamcinolone acetonide in alopecia areata. Br J Dermatol 1971; 85: 272-3.
27. Kubeyinje EP,. Intralesional triamcinolone acetonide in alopecia areata amongst 62 Saudi Arabs. East Afr Med J 1994; 71: 674-5.
28. Abell E, Munro DD,. Intralesional treatment of alopecia areata with triamcinolone acetonide by jet injector. Br J Dermatol 1973; 88: 55-9.
29. Carnahan MC, Goldstein DA,. Ocular complications of topical, peri-ocular, and systemic corticosteroids. Curr Opin Ophthalmol 2000; 11: 478-83.
30. Downs AM, Lear JT, Kennedy CT,. Anaphylaxis to intradermal triamcinolone acetonide. Arch Dermatol 1998; 134: 1163-4.
31. Laing ME, Fallis B, Murphy GM,. Anaphylactic reaction to intralesional corticosteroid injection. Contact Dermatitis 2007; 57: 132-3. (Pubitemid 47052282)
32. Olsen EA, Carson SC, Turney EA,. Systemic steroids with or without 2% topical minoxidil in the treatment of alopecia areata. Arch Dermatol 1992; 128: 1467-73.
33. Winter RJ, Kern F, Blizzard RM,. Prednisone therapy for alopecia areata. A follow-up report. Arch Dermatol 1976; 112: 1549-52.
34. Burton JL, Shuster S,. Large doses of glucocorticoid in the treatment of alopecia areata. Acta Derm Venereol 1975; 55: 493-6.
35. Friedli A, Labarthe MP, Engelhardt E, et al. Pulse methylprednisolone therapy for severe alopecia areata: an open prospective study of 45 patients. J Am Acad Dermatol 1998; 39: 597-602. (Pubitemid 28465883)
36. Perriard-Wolfensberger J, Pasche-Koo F, Mainetti C, et al. Pulse of methylprednisolone in alopecia areata. Dermatology 1993; 187: 282-5. (Pubitemid 23333942)
37. Sharma VK,. Pulsed administration of corticosteroids in the treatment of alopecia areata. Int J Dermatol 1996; 35: 133-6. (Pubitemid 26072793)
38. Sharma VK, Gupta S,. Twice weekly 5 mg dexamethasone oral pulse in the treatment of extensive alopecia areata. J Dermatol 1999; 26: 562-5. (Pubitemid 29462750)
39. Kar BR, Handa S, Dogra S, et al. Placebo-controlled oral pulse prednisolone therapy in alopecia areata. J Am Acad Dermatol 2005; 52: 287-90.
40. Hubiche T, Leaute-Labreze C, Taieb A, et al. Poor long-term outcome of severe alopecia areata in children treated with high-dose pulse corticosteroid therapy. Br J Dermatol 2008; 158: 1136-7. (Pubitemid 351521428)
41. Rosenberg EW, Drake L,. Alopecia areata. Arch Dermatol 1976; 112: 256.
42. Summer KH, Goggelmann W,. 1-Chloro-2,4-dinitrobenzene depletes glutathione in rat skin and is mutagenic in Salmonella typhimurium. Mutat Res 1980; 77: 91-3. (Pubitemid 10163615)
43. Wilkerson MG, Connor TH, Henkin J, et al. Assessment of diphenylcyclopropenone for photochemically induced mutagenicity in the Ames assay. J Am Acad Dermatol 1987; 17: 606-11. (Pubitemid 17147803)
44. Happle R, Hausen BM, Wiesner-Menzel L,. Diphencyprone in the treatment of alopecia areata. Acta Derm Venereol 1983; 63: 49-52. (Pubitemid 13172544)
45. Rokhsar CK, Shupack JL, Vafai JJ, et al. Efficacy of topical sensitizers in the treatment of alopecia areata. J Am Acad Dermatol 1998; 39: 751-61. (Pubitemid 28519028)
46. van der Steen PH, van Baar HM, Happle R, et al. Prognostic factors in the treatment of alopecia areata with diphenylcyclopropenone. J Am Acad Dermatol 1991; 24: 227-30.
47. Gordon PM, Aldrige RD, McVittie E, et al. Topical diphencyprone for alopecia areata: evaluation of 48 cases after 30 months' follow-up. Br J Dermatol 1996; 134: 869-71. (Pubitemid 26151401)
48. Wiseman MC, Shapiro J, MacDonald N, et al. Predictive model for immunotherapy of alopecia areata with diphencyprone. Arch Dermatol 2001; 137: 1063-8. (Pubitemid 32756464)
49. MacDonald Hull S, Pepall L, Cunliffe WJ,. Alopecia areata in children: response to treatment with diphencyprone. Br J Dermatol 1991; 125: 164-8.
50. Schuttelaar ML, Hamstra JJ, Plinck EP, et al. Alopecia areata in children: treatment with diphencyprone. Br J Dermatol 1996; 135: 581-5. (Pubitemid 26340270)
51. Tosti A, Guidetti MS, Bardazzi F, et al. Long-term results of topical immunotherapy in children with alopecia totalis or alopecia universalis. J Am Acad Dermatol 1996; 35: 199-201.
52. Tosti A, Guerra L, Bardazzi F,. Contact urticaria during topical immunotherapy. Contact Dermatitis 1989; 21: 196-7. (Pubitemid 19223037)
53. Alam M, Gross EA, Savin RC,. Severe urticarial reaction to diphenylcyclopropenone therapy for alopecia areata. J Am Acad Dermatol 1999; 40: 110-12. (Pubitemid 29051037)
54. Henderson CA, Ilchyshyn A,. Vitiligo complicating diphencyprone sensitization therapy for alopecia universalis. Br J Dermatol 1995; 133: 496-7.
55. Macdonald Hull S, Norris JF, Cotterill JA,. Vitiligo following sensitization with diphencyprone. Br J Dermatol 1989; 120: 323.
56. Claudy AL, Gagnaire D,. PUVA treatment of alopecia areata. Arch Dermatol 1983; 119: 975-8. (Pubitemid 14203356)
57. Lassus A, Eskelinen A, Johansson E,. Treatment of alopecia areata with three different PUVA modalities. Photodermatology 1984; 1: 141-4. (Pubitemid 14028162)
58. van der Schaar WW, Sillevis Smith JH,. An evaluation of PUVA-therapy for alopecia areata. Dermatologica 1984; 168: 250-2. (Pubitemid 14132554)
59. Mitchell AJ, Douglass MC,. Topical photochemotherapy for alopecia areata. J Am Acad Dermatol 1985; 12: 644-9. (Pubitemid 15106040)
60. Taylor CR, Hawk JL,. PUVA treatment of alopecia areata partialis, totalis and universalis: audit of 10 years' experience at St John's Institute of Dermatology. Br J Dermatol 1995; 133: 914-18. (Pubitemid 26009745)
61. Healy E, Rogers S,. PUVA treatment for alopecia areata-does it work? A retrospective review of 102 cases Br J Dermatol 1993; 129: 42-4. (Pubitemid 23211046)
62. Fenton DA, Wilkinson JD,. Topical minoxidil in the treatment of alopecia areata. Br Med J 1983; 287: 1015-17. (Pubitemid 13009245)
63. Vestey JP, Savin JA,. A trial of 1% minoxidil used topically for severe alopecia areata. Acta Derm Venereol 1986; 66: 179-80. (Pubitemid 16167328)
64. Price VH,. Double-blind, placebo-controlled evaluation of topical minoxidil in extensive alopecia areata. J Am Acad Dermatol 1987; 16: 730-6. (Pubitemid 17031782)
65. Ranchoff RE, Bergfeld WF, Steck WD, et al. Extensive alopecia areata. Results of treatment with 3% topical minoxidil. Cleveland Clin J Med 1989; 56: 149-54. (Pubitemid 19168216)
66. Fiedler-Weiss VC,. Topical minoxidil solution (1% and 5%) in the treatment of alopecia areata. J Am Acad Dermatol 1987; 16: 745-8. (Pubitemid 17031784)
67. Fiedler-Weiss VC, Buys CM,. Evaluation of anthralin in the treatment of alopecia areata. Arch Dermatol 1987; 123: 1491-3.
68. Nelson DA, Spielvogel RL,. Anthralin therapy for alopecia areata. Int J Dermatol 1985; 24: 606-7. (Pubitemid 16230359)
69. Schmoeckel C, Weissmann I, Plewig G, et al. Treatment of alopecia areata by anthralin-induced dermatitis. Arch Dermatol 1979; 115: 1254-5. (Pubitemid 10153582)
70. Gupta AK, Ellis CN, Cooper KD, et al. Oral cyclosporine for the treatment of alopecia areata. A clinical and immunohistochemical analysis. J Am Acad Dermatol 1990; 22: 242-50. (Pubitemid 20209097)
71. Shapiro J, Lui H, Tron V, et al. Systemic cyclosporine and low-dose prednisone in the treatment of chronic severe alopecia areata: a clinical and immunopathologic evaluation. J Am Acad Dermatol 1997; 36: 114-17. (Pubitemid 27043889)
72. Price VH, Willey A, Chen BK,. Topical tacrolimus in alopecia areata. J Am Acad Dermatol 2005; 52: 138-9. (Pubitemid 40038949)
73. Coronel-Perez IM, Rodriguez-Rey EM, Camacho-Martinez FM,. Latanoprost in the treatment of eyelash alopecia in alopecia areata universalis. J Eur Acad Dermatol Venereol 2010; 24: 481-5.
74. Roseborough I, Lee H, Chwalek J, et al. Lack of efficacy of topical latanoprost and bimatoprost ophthalmic solutions in promoting eyelash growth in patients with alopecia areata. J Am Acad Dermatol 2009; 60: 705-6.
75. Faghihi G, Andalib F, Asilian A,. The efficacy of latanoprost in the treatment of alopecia areata of eyelashes and eyebrows. Eur J Dermatol 2009; 19: 586-7.
76. Ferran M, Calvet J, Almirall M, et al. Alopecia areata as another immune-mediated disease developed in patients treated with tumour necrosis factor-alpha blocker agents: report of five cases and review of the literature. J Eur Acad Dermatol Venereol 2011; 25: 479-84.
77. Strober BE, Siu K, Alexis AF, et al. Etanercept does not effectively treat moderate to severe alopecia areata: an open-label study. J Am Acad Dermatol 2005; 52: 1082-4. (Pubitemid 40732553)
78. Strober BE, Menon K, McMichael A, et al. Alefacept for severe alopecia areata: a randomized, double-blind, placebo-controlled study. Arch Dermatol 2009; 145: 1262-6.
79. Ellis CN, Brown MF, Voorhees JJ,. Sulfasalazine for alopecia areata. J Am Acad Dermatol 2002; 46: 541-4.
80. Bakar O, Gurbuz O,. Is there a role for sulfasalazine in the treatment of alopecia areata? J Am Acad Dermatol 2007; 57: 703-6. (Pubitemid 47384907)
81. Rashidi T, Mahd AA,. Treatment of persistent alopecia areata with sulfasalazine. Int J Dermatol 2008; 47: 850-2.
82. Aghaei S,. An uncontrolled, open label study of sulfasalazine in severe alopecia areata. Indian J Dermatol Venereol Leprol 2008; 74: 611-13.
83. Joly P,. The use of methotrexate alone or in combination with low doses of oral corticosteroids in the treatment of alopecia totalis or universalis. J Am Acad Dermatol 2006; 55: 632-6. (Pubitemid 44436626)
84. Lowy M, Ledoux-Corbusier M, Achten G, et al. Clinical and immunologic response to Isoprinosine in alopecia areata and alopecia universalis: association with autoantibodies. J Am Acad Dermatol 1985; 12: 78-84. (Pubitemid 15188849)
85. Berth-Jones J, Hutchinson PE,. Treatment of alopecia totalis with a combination of inosine pranobex and diphencyprone compared to each treatment alone. Clin Exp Dermatol 1991; 16: 172-5.
86. Georgala S, Katoulis AC, Befon A, et al. Inosiplex for treatment of alopecia areata: a randomized placebo-controlled study. Acta Derm Venereol 2006; 86: 422-4. (Pubitemid 44450098)
87. Waiz M, Saleh AZ, Hayani R, et al. Use of the pulsed infrared diode laser (904 nm) in the treatment of alopecia areata. J Cosmet Laser Ther 2006; 8: 27-30.
88. Al-Mutairi N,. 308-nm excimer laser for the treatment of alopecia areata. Dermatol Surg 2007; 33: 1483-7. (Pubitemid 350212687)
89. Al-Mutairi N,. 308-nm excimer laser for the treatment of alopecia areata in children. Pediatr Dermatol 2009; 26: 547-50.
90. Hay IC, Jamieson M, Ormerod AD,. Randomized trial of aromatherapy. Successful treatment for alopecia areata. Arch Dermatol 1998; 134: 1349-52.
91. Willemsen R, Haentjens P, Roseeuw D, et al. Hypnosis in refractory alopecia areata significantly improves depression, anxiety, and life quality but not hair regrowth. J Am Acad Dermatol 2010; 62: 517-18.
92. Welsh N, Guy A,. The lived experience of alopecia areata: a qualitative study. Body Image 2009; 6: 194-200.