Treatment of alopecia areata: An Australian expert consensus statement

<jats:title>Abstract</jats:title><jats:p>Alopecia areata (<jats:styled-content style="fixed-case">AA</jats:styled-content>) severity varies from a single small patch to complete loss of scalp hair, body hair, eyelashes and eyebrows. While 40% of all affected individuals only ever get one patch and will achieve a spontaneous complete durable remission within 6 months, 27% will develop additional patches but still achieve complete durable remission within 12 months and 33% will develop chronic <jats:styled-content style="fixed-case">AA</jats:styled-content>. Without systemic treatment, 55% of individuals with chronic <jats:styled-content style="fixed-case">AA</jats:styled-content> will have persistent multifocal relapsing and remitting disease, 30% will ultimately develop alopecia totalis and 15% will develop alopecia universalis. The unpredictable course and psychological distress attributable to <jats:styled-content style="fixed-case">AA</jats:styled-content> contributes to the illness associated with <jats:styled-content style="fixed-case">AA</jats:styled-content>. Numerous topical, intralesional and systemic agents are currently used to treat <jats:styled-content style="fixed-case">AA</jats:styled-content>; however, there is a paucity of data evaluating their use, effectiveness and tolerability. Topical therapy, including topical glucocorticosteroids, minoxidil and immunotherapy, can be used in cases of limited disease. There are no universally agreed indications for initiating systemic treatment for <jats:styled-content style="fixed-case">AA</jats:styled-content>. Possible indications for systemic treatment include rapid hair loss, extensive disease (≥50% hair loss), chronic disease, severe distress or a combination of these factors. Currently available systemic treatments include glucocorticosteroids, methotrexate, ciclosporin, azathioprine, dapsone, mycophenolate mofetil, tacrolimus and sulfasalazine. The optimal treatment algorithm has not yet been described. The purpose of this consensus statement is to outline a treatment algorithm for <jats:styled-content style="fixed-case">AA</jats:styled-content>, including the indications for systemic treatment, appropriate choice of systemic treatment, satisfactory outcome measures and when to discontinue successful or unsuccessful treatment.</jats:p>