Treatments for alopecia areata, alopecia totalis and alopecia universalis

Delamere FM, Sladden MJ, Dobbins HM, Leonardi-Bee J

Published Online:

July 16, 2008

There is no good trial evidence that any treatments provide long-term benefit to patients with alopecia areata, alopecia totalis and alopecia universalis.

Alopecia areata is a condition that causes patchy hair loss. The size and number of patches and progress of the disease can vary between people. It can affect the entire scalp (alopecia totalis) or cause loss of all body hair (alopecia universalis). Sometimes the condition will get better on its own, but in some cases it can get worse.

Treatments include a variety of different creams or lotions applied to the scalp such as topical or oral corticosteroids, minoxidil and some light-based therapies. Some of the skin treatments can have unpleasant side effects such as itching or hair growth in areas of the body away from where the cream was applied. Oral steroids may cause serious side effects. Also, there is no guarantee that any hair regrown during treatment will persist once the treatment is finished.

We found 17 randomised controlled trials involving 540 participants. Only one study which compared two topical corticosteroids showed significant short-term benefits. No studies showed long-term beneficial hair growth. None of the included studies asked participants to report their opinion of hair growth or whether their quality of life had improved with the treatment.

Abstract (click to read)

Background:

Alopecia areata is a disorder in which there is loss of hair causing patches of baldness but with no scarring of the affected area. It can affect the entire scalp (alopecia totalis) or cause loss of all body hair (alopecia universalis). It is a relatively common condition affecting 0.15% of the population. Although in many cases it can be a self-limiting condition, nevertheless hair loss can often have a severe social and emotional impact.

Objectives:

To assess the effects of interventions used in the management of alopecia areata, alopecia totalis and alopecia universalis.

Search strategy:

We searched the Cochrane Skin Group Specialised Register in February 2006, the Cochrane Central Register of Controlled Clinical Trials (The Cochrane Library Issue 1, 2006), MEDLINE (from 2003 to February 2006), EMBASE (from 2005 to February 2006), PsycINFO (from 1806 to February 2006), AMED (Allied and Complementary Medicine, from 1985 to February 2006), LILACS (Latin American and Caribbean Health Science Information database, from 1982 to February 2006), and reference lists of articles. We also searched online trials registries for ongoing trials.

Selection criteria:

Randomised controlled trials that evaluated the effectiveness of both topical and systemic interventions for alopecia areata, alopecia totalis, and alopecia universalis.

Data collection and analysis:

Two authors assessed trial quality and extracted the data. We contacted trial authors for more information. We collected adverse effects information from the included trials.

Main results:

Seventeen trials were included with a total of 540 participants. Each trial included from 6 to 85 participants and they assessed a range of interventions that included topical and oral corticosteroids, topical ciclosporin, photodynamic therapy and topical minoxidil. Overall, none of the interventions showed significant treatment benefit in terms of hair growth when compared with placebo. We did not find any studies where the participants self-assessed their hair growth or quality of life.

Authors' conclusions:

Few treatments for alopecia areata have been well evaluated in randomised trials. We found no RCTs on the use of diphencyprone, dinitrochlorobenzene, intralesional corticosteroids or dithranol although they are commonly used for the treatment of alopecia areata. Similarly although topical steroids and minoxidil are widely prescribed and appear to be safe, there is no convincing evidence that they are beneficial in the long-term. Most trials have been reported poorly and are so small that any important clinical benefits are inconclusive. There is a desperate need for large well conducted studies that evaluate long-term effects of therapies on quality of life.

Considering the possibility of spontaneous remission especially for those in the early stages of the disease, the options of not being treated therapeutically or, depending on individual preference wearing a wig may be alternative ways of dealing with this condition.

This record should be cited as:

Delamere FM, Sladden MJ, Dobbins HM, Leonardi-Bee J. Interventions for alopecia areata. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD004413. DOI: 10.1002/14651858.CD004413.pub2

Assessed as up to date:

December 5, 2007

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Primary Review Group:

Skin Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective are treatments for alopecia?

Bottom line:

There is no good trial evidence that any treatments provide long-term benefit to patients with alopecia areata, alopecia totalis and alopecia universalis. There are no randomised controlled trials on the use of diphencyprone, dinitrochlorobenzene, intralesional corticosteroids or dithranol, although they are commonly used for the treatment of alopecia areata. Similarly, although topical steroids and minoxidil are widely prescribed and appear to be safe, there is no convincing evidence that they are beneficial in the long-term.

Caveat:

Most trials have been reported poorly and are so small that any important clinical benefits are inconclusive. Some of the skin treatments can have unpleasant side effects, such as itching or hair growth in areas of the body away from where the cream was applied. Oral steroids may cause serious side effects. Also, there is no guarantee that any hair regrown during treatment will persist once treatment is finished. None of the studies asked participants to report their opinion of hair growth or whether their quality of life had improved with treatment.

Context:

Alopecia areata is a condition that causes patchy hair loss. The size and number of patches and progress of the disease can vary between people. It can affect the entire scalp (alopecia totalis) or cause loss of all body hair (alopecia universalis). It is a relatively common condition, affecting 0.15% of the population. Although in many cases it can be a self-limiting condition, nevertheless hair loss can often have a severe social and emotional impact.

Cochrane Systematic Review:

Delamere FM et al. Interventions for alopecia areata. Cochrane Reviews 2008, Issue 1. Art. No.: CD004413. DOI:10.1002/14651858.CD004413.pub2. This review contains 17 studies involving 540 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Skin > Disorders of hair & nails > Hair loss

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Treatments for alopecia areata, alopecia totalis and alopecia universalis

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