First-Line Failure — Escalation Indicated

This protocol applies when topical corticosteroid therapy — at strong, very strong, or strongest class, applied to the affected scalp — has not produced at least 25% hair regeneration by 12 weeks. That threshold is the defined response criterion; failure to reach it is the trigger for this next-line step.

Next-Line Approach (Partial Overview)

The indicated strategy introduces combination therapy — adding a complementary adjunctive agent to the ongoing regimen. This agent may be topical, physical, or oral, and is selected based on individual patient characteristics. For patients with an atopic predisposition, a specific oral approach may also be considered. The full selection criteria, options, and regimen structure are available in the complete protocol.

References

DOI: 10.14924/dermatol.134.2491

However, considering clinical results in other countries, this therapy may be performed as a regimen of combination therapy.
Furthermore, this therapy is not covered by health insurance, but it may be primarily performed in standard-type (solitary or multiple) AA patients as a regimen of combination therapy, considering the simple procedure and very mild adverse reactions.
Considering coverage by health insurance and the safety secured by clinical results in Japan, oral cepharanthin therapy may be performed as a regimen of combination therapy in solitary and multiple AA patients.
However, considering coverage by health insurance and the safety secured by clinical results in Japan, this therapy may be performed as a regimen of combination therapy in solitary and multiple AA patients.
Considering coverage by health insurance and the long-term safety secured by clinical results in Japan, this therapy may be performed as a regimen of combination therapy in mild solitary and multiple AA patients.
Therefore, oral antihistamine therapy may be performed as a regimen of combination therapy to obtain atopic predisposition-improving effects in AA patients with atopic predispositions.

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Alopecia Areata: Treatment When Topical Corticosteroids Have Not Achieved 25% Hair Regrowth at 12 Weeks

References