When alopecia areata presents with a rapidly progressive course — sudden onset, markedly increased shedding, and confirmed active disease — early systemic intervention is indicated to arrest ongoing loss and support regrowth.
Rapidly progressive AA is characterised by progressive scalp hair loss of sudden onset, accompanied by increased hair fall. A generalised positive hair pull test and/or trichoscopic features of active disease — such as exclamation-mark hairs or black dots — confirm that the condition is advancing. This pattern requires prompt assessment and a targeted treatment approach.
The primary aims are to halt the progressive loss of scalp hair and to encourage initial hair regrowth.
For rapidly progressive AA, systemic options are considered. These include a short course of corticosteroids — which may be given orally or, in some adults, intravenously — as well as an immunomodulatory agent over a limited period. The full regimen, including agent selection, route, duration, and sequencing, is detailed in the structured protocol.
DOI: 10.1093/bjd/ljae385