Adults aged 18 years or older with solitary or multiple alopecia areata, where hair loss affects 25% or less of the scalp (classified as S1 or lower), who have not responded sufficiently to initial treatment.
The preceding step used intralesional corticosteroid injection or a topical corticosteroid applied to the area of alopecia. This protocol is indicated when the patient has not achieved at least 25% hair regeneration of the scalp by 12 weeks — the threshold that defines an inadequate response at that line.
The protocol introduces a combination strategy: an additional agent is added alongside the initial approach. Several evidence-based options are available, each evaluated in the context of insurance coverage and safety data from clinical use. Which option is appropriate — and how it is integrated — is detailed in the full structured regimen.
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.
However, considering clinical results in other countries, this therapy may be performed as a regimen of combination therapy.
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.
DOI: 10.14924/dermatol.134.2491
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