Clinical Scenario

This protocol covers alopecia areata presenting with limited (mild) to moderate scalp hair loss, defined as 1–49% scalp involvement. Limited (mild) loss refers to 1–20% involvement; moderate loss to 21–49% involvement.

First-Line Treatment Approach

The evidence-based first-line approach centres on topical corticosteroid therapy. An intralesional corticosteroid option is available as an alternative first-line route for adults, and may be considered in selected younger patients and in non-scalp sites on a case-by-case basis.

Full details — agent selection, schedule, treatment intervals, and age-specific regimens — are available in the complete protocol.

Treatment Goals

Response is reassessed every 3–6 months. The aim is progressive improvement in hair regrowth from baseline, with the ultimate goal of complete terminal hair regrowth on the scalp.

References

DOI: 10.1093/bjd/ljae385

The AA severity definitions used in this living guideline are based primarily on the extent of scalp hair loss, with limited (mild) hair loss representing 1–20% scalp involvement, moderate hair loss representing 21–49% scalp involvement and severe hair loss representing 50–100% scalp involvement.
Offer* a potent or very potent topical corticosteroid once daily for 3–6 months to people with AA who have scalp hair loss, as the first-line treatment in primary or secondary care.
Offer* intralesional triamcinolone acetonide (2.5–10 mg mL−1) as a first-line option to adults with limited (mild)-to-moderate AA.
Consider intralesional triamcinolone acetonide in older children and young people with limited (mild)-to-moderate AA on a case-by-case basis.
Reassess the use of topical corticosteroids every 3–6 months in people with AA, to assess for improvement and cutaneous side-effects.
Ultimately, the aim of treatment is complete terminal hair regrowth on the scalp and any other body site affected.

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Treatment of Alopecia Areata with Limited to Moderate Scalp Hair Loss (1–49% Scalp Involvement)

Clinical Scenario

First-Line Treatment Approach

Treatment Goals

References