Treatment of Alopecia Areata in Adults Aged 18 or Older with Solitary or Multiple Limited Patches (S1 or Lower)
This protocol covers the first-line management of alopecia areata in adult patients — those 18 years of age or older — who present with one or more discrete patches where the total affected area does not exceed 25% of the scalp surface.
Clinical Scenario
Patient is 18 years or older with solitary or multiple alopecia areata foci. The combined area of hair loss is at or below the S1 threshold — that is, less than 25% of the scalp surface is affected.
Treatment Approach — Partial Overview
The recommended approach for adults with localised alopecia areata (S1 or lower) centres on intralesional corticosteroid injection, with topical corticosteroid therapy as an established alternative. The complete regimen — including agents, step-by-step dosing guidance, session scheduling, and the full decision algorithm — is available in the structured protocol below.
Clinical Goal
At least 25% hair regeneration of the scalp at 12 weeks.
References
DOI: 10.14924/dermatol.134.2491
- Based on the efficacy and treatment results in the above previous studies, as a rule, intralesional corticosteroid injection is recommended for adults with S1 or lower localized alopecia foci.
- S1: < 25% hair loss of the scalp.
- Intralesional corticosteroid injection therapy is recommended for adults with solitary or multiple AA.
- Briefly, it is recommended to perform topical corticosteroid (strong, very strong, or strongest class) therapy once to twice a day in patients with solitary to alopecia-spot-fusion-tendency-free multiple AA.
- There is a highly reliable report from a RCT regarding the simple application of 0.25% desoximetasone cream and its base (twice a day, 12 weeks) in 54 patients with alopecia spots with a clear border, describing that the rate of patients with ≥ 25% hair regeneration was significantly higher in the drug application group, whereas there was no significant difference in complete hair recovery between the two groups.