Interventions for alopecia areata

“Circular patches of hair loss, with no scarring to the affected area, can be a sign of alopecia areata, a distressing condition which can affect all the hair on the scalp and body. We don't yet understand the cause of alopecia areata but it can start at any age, usually before the age of 20. Men and women are affected equally and it's a relatively common condition all around the world. Treatments that have been suggested and used include a variety of creams or lotions applied to the scalp such as topical minoxidil, and some ultraviolet light-based therapies. Oral medications, such as corticosteroids, have also been tried. Some of the skin treatments can have unpleasant side effects, including itchiness or hair growth in areas of the body away from where the cream was applied. While, oral steroids in particular may cause serious side effects. And, even if the treatment does lead to hair re-growth, there is no guarantee that this will remain when the treatment is stopped. To complicate matters even more, alopecia areata sometimes clears up without treatment. So, if hair does grow back during treatment, it is difficult to know whether this would have happened anyway. This means that for studies to be reliable, they need to include a control group of people who do not get the treatment. We set out to see if, on balance, these treatments are helpful and found 17 randomised controlled trials, involving 540 participants. The trials were fairly small, ranging in size from just 6 people to 85. They assessed a range of treatments that included topical and oral steroids, topical ciclosporin, photodynamic therapy and topical minoxidil. We found no randomised trials on some other common treatments, such as diphencyprone, dinitrochlorobenzene, intralesional corticosteroids and dithranol. No studies showed long-term beneficial hair growth. Overall, none of the treatments were significantly better than placebo in terms of hair growth; but most of the trials were reported so poorly and were so small that they may have missed clinically important benefits. Answers are still needed. Future studies need to be much larger and to compare the treatment against a placebo. Similarly, because short-term interventions might not ‘cure’ alopecia areata or lead to long-term benefit, these trials should focus on treatments that are safe and sustainable. Future studies should also measure and report the feelings of the participants about their hair growth or quality of life. We would also like to see trials testing good quality wigs and other supportive therapies against pharmaceutical interventions. Such trials, using patient satisfaction outcomes, would be invaluable.” This systematic review is available in full in The Cochrane Library (http://www.thecochranelibrary.com): Delamere FM, Sladden MJ, Dobbins HM, Leonardi-Bee J. Interventions for alopecia areata. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD004413. DOI: 10.1002/14651858.CD004413.pub2.