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Treatment Options for Alopecia Areata in Children and Adolescents

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Abstract

Alopecia areata (AA) lifetime incidence is around 2%, with many patients first experiencing symptoms during childhood. However, ritlecitinib is the only FDA-approved treatment for pediatric patients 12 years and older. This review outlines reported topical, injectable, and oral treatment options for pediatric patients with AA. Clinical studies were obtained via a PubMed search using the following search terms: alopecia areata, areata, universalis, or totalis and medication, therapy, treatment, drug, or management. Only studies with pediatric patients were included in this review. Commonly used therapies, including corticosteroids, methotrexate, and minoxidil, newer promising medications, such as Janus kinase inhibitors, and less frequently used topical and systemic treatments are included. A summary of the drug development pipeline and ongoing interventional clinical trials with pediatric patients is provided. Treatments demonstrate variable efficacy, and many patients require combination therapy for maximal response. More robust clinical data is needed for many of the medications reviewed in order to provide better care for these patients.

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References

  1. Mirzoyev SA, Schrum AG, Davis MDP, Torgerson RR. Lifetime incidence risk of alopecia areata estimated at 2.1% by Rochester Epidemiology Project, 1990–2009. J Invest Dermatol. 2014;134(4):1141–2. https://doi.org/10.1038/jid.2013.464. (Epub 2013 Nov 11).

    Article  CAS  PubMed  Google Scholar 

  2. Kyriakis KP, Paltatzidou K, Kosma E, Sofouri E, Tadros A, Rachioti E. Alopecia areata prevalence by gender and age. J Eur Acad Dermatol Venereol. 2009;23(5):572–3. https://doi.org/10.1111/j.1468-3083.2008.02956.x. (Epub 2008 Sep 3).

    Article  CAS  PubMed  Google Scholar 

  3. McKenzie PL, Maltenfort M, Bruckner AL, Gupta D, Harfmann KL, Hyde P, Forrest CB, Castelo-Soccio L. Evaluation of the prevalence and incidence of pediatric alopecia areata using electronic health record data. JAMA Dermatol. 2022;158(5):547–51. https://doi.org/10.1001/jamadermatol.2022.0351.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ali NS, Tollefson MM, Lohse CM, Torgerson RR. Incidence and comorbidities of pediatric alopecia areata: a retrospective matched cohort study using the Rochester Epidemiology Project. J Am Acad Dermatol. 2022;87(2):427–9. https://doi.org/10.1016/j.jaad.2021.08.050. (Epub 2021 Sep 4).

    Article  PubMed  Google Scholar 

  5. Caldwell CC, Saikaly SK, Dellavalle RP, Solomon JA. Prevalence of pediatric alopecia areata among 572,617 dermatology patients. J Am Acad Dermatol. 2017;77(5):980–1. https://doi.org/10.1016/j.jaad.2017.06.035.

    Article  PubMed  Google Scholar 

  6. Strazzulla LC, Wang EHC, Avila L, Lo Sicco K, Brinster N, Christiano AM, Shapiro J. Alopecia areata: disease characteristics, clinical evaluation, and new perspectives on pathogenesis. J Am Acad Dermatol. 2018;78(1):1–12. https://doi.org/10.1016/j.jaad.2017.04.1141.

    Article  PubMed  Google Scholar 

  7. Olsen E, Hordinsky M, McDonald-Hull S, Price V, Roberts J, Shapiro J, Stenn K. Alopecia areata investigational assessment guidelines. National Alopecia Areata Foundation. J Am Acad Dermatol. 1999;40(2 Pt 1):242–6. https://doi.org/10.1016/s0190-9622(99)70195-7.

    Article  CAS  PubMed  Google Scholar 

  8. Olsen EA, Hordinsky MK, Price VH, Roberts JL, Shapiro J, Canfield D, Duvic M, King LE Jr, McMichael AJ, Randall VA, Turner ML, Sperling L, Whiting DA, Norris D; National Alopecia Areata Foundation. Alopecia areata investigational assessment guidelines—Part II. National Alopecia Areata Foundation. J Am Acad Dermatol. 2004;51(3):440–7. https://doi.org/10.1016/j.jaad.2003.09.032.

  9. Olsen EA, Hordinsky MK, Price VH, Roberts JL, Shapiro J, Canfield D, Duvic M, King LE Jr, McMichael AJ, Randall VA, Turner ML, Sperling L, Whiting DA, Norris D. Severity of Alopecia Tool (SALT) scoring tool.

  10. Zhou C, Li X, Wang C, Zhang J. Alopecia areata: an update on etiopathogenesis, diagnosis, and management. Clin Rev Allergy Immunol. 2021;61(3):403–23. https://doi.org/10.1007/s12016-021-08883-0. (Epub 2021 Aug 17).

    Article  PubMed  Google Scholar 

  11. Commissioner, O. of the. 2022. FDA approves first systemic treatment for alopecia areata. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-first-systemic-treatment-alopecia-areata. Accessed 12 Sept 2023.

  12. Highlights of prescribing information. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/215830s000lbl.pdf. Accessed 4 Sept 2024.

  13. Barton VR, Toussi A, Awasthi S, Kiuru M. Treatment of pediatric alopecia areata: a systematic review. J Am Acad Dermatol. 2022;86(6):1318–34. https://doi.org/10.1016/j.jaad.2021.04.077. (Epub 2021 Apr 30).

    Article  CAS  PubMed  Google Scholar 

  14. Lenane P, Macarthur C, Parkin PC, et al. Clobetasol propionate, 0.05%, vs hydrocortisone, 1%, for alopecia areata in children: a randomized clinical trial. JAMA Dermatol. 2014;150(1):47–50.

    Article  CAS  PubMed  Google Scholar 

  15. Montes LF. Topical halcinonide in alopecia areata and in alopecia totalis. J Cutan Pathol. 1977;4(2):47–50.

    Article  CAS  PubMed  Google Scholar 

  16. Meah N, Wall D, York K, Bhoyrul B, Bokhari L, Sigall DA, Bergfeld WF, Betz RC, Blume-Peytavi U, Callender V, Chitreddy V, Combalia A, Cotsarelis G, Craiglow B, Donovan J, Eisman S, Farrant P, Green J, Grimalt R, Harries M, Hordinsky M, Irvine AD, Itami S, Jolliffe V, King B, Lee WS, McMichael A, Messenger A, Mirmirani P, Olsen E, Orlow SJ, Piraccini BM, Rakowska A, Reygagne P, Roberts JL, Rudnicka L, Shapiro J, Sharma P, Tosti A, Vogt A, Wade M, Yip L, Zlotogorski A, Sinclair R. The Alopecia Areata Consensus of Experts (ACE) study: Results of an international expert opinion on treatments for alopecia areata. J Am Acad Dermatol. 2020;83(1):123–30. https://doi.org/10.1016/j.jaad.2020.03.004. (Epub 2020 Mar 9).

    Article  PubMed  Google Scholar 

  17. Chang KH, Rojhirunsakool S, Goldberg LJ. Treatment of severe alopecia areata with intralesional steroid injections. J Drugs Dermatol. 2009;8(10):909–12.

    PubMed  Google Scholar 

  18. Abell E, Munro DD. Intralesional treatment of alopecia areata with triamcinolone acetonide by jet injector. Br J Dermatol. 1973;88(1):55–9.

    Article  CAS  PubMed  Google Scholar 

  19. Suchonwanit P, Thammarucha S, Leerunyakul K. Minoxidil and its use in hair disorders: a review. Drug Des Devel Ther. 2019;13:2777–86. https://doi.org/10.2147/DDDT.S214907. (Erratum in: Drug Des Devel Ther. 2020 Feb 10;14:575).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Abdallah MAE, Shareef R, Soltan MY. Efficacy of intradermal minoxidil 5% injections for treatment of patchy non-severe alopecia areata. J Dermatol Treat. 2022;33(2):1126–9.

    Article  CAS  Google Scholar 

  21. Fenton DA, Wilkinson JD. Topical minoxidil in the treatment of alopecia areata. Br Med J (Clin Res Ed). 1983;287(6398):1015–7.

    Article  CAS  PubMed  Google Scholar 

  22. Price VH. Double-blind, placebo-controlled evaluation of topical minoxidil in extensive alopecia areata. J Am Acad Dermatol. 1987;16(3 Pt 2):730–6.

    Article  CAS  PubMed  Google Scholar 

  23. Georgala S, Befon A, Maniatopoulou E, Georgala C. Topical use of minoxidil in children and systemic side effects. Dermatology. 2007;214(1):101–2.

    Article  CAS  PubMed  Google Scholar 

  24. Rai AK. Minoxidil-induced hypertrichosis in a child with alopecia areata. Indian Dermatol Online J. 2017;8(2):147–8.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Weiss VC, West DP, Mueller CE. Topical minoxidil in alopecia areata. J Am Acad Dermatol. 1981;5(2):224–6.

    Article  CAS  PubMed  Google Scholar 

  26. Center for Drug Evaluation and Research. (n.d.). DRUGS@FDA data files. U.S. Food and Drug Administration. https://www.fda.gov/drugs/drug-approvals-and-databases/drugsfda-data-files. Accessed 12 Sept 2023.

  27. Craiglow BG, Tavares D, King BA. Topical ruxolitinib for the treatment of alopecia universalis. JAMA Dermatol. 2016;152(4):490–1.

    Article  PubMed  Google Scholar 

  28. Bayart CB, DeNiro KL, Brichta L, Craiglow BG, Sidbury R. Topical Janus kinase inhibitors for the treatment of pediatric alopecia areata. J Am Acad Dermatol. 2017;77(1):167–70.

    Article  PubMed  Google Scholar 

  29. Putterman E, Castelo-Soccio L. Topical 2% tofacitinib for children with alopecia areata, alopecia totalis, and alopecia universalis. J Am Acad Dermatol. 2018;78(6):1207-1209.e1.

    Article  PubMed  Google Scholar 

  30. Khan FA, Hussain M, Khan BM, et al. Comparative study between intralesional injection of platelet rich plasma and intra lesional triamcinolone for the treatment of alopecia areata. J Ayub Med Coll Abbottabad. 2022;34(4):762–5.

    Article  PubMed  Google Scholar 

  31. El Taieb MA, Ibrahim H, Nada EA, Seif A-DM. Platelets rich plasma versus minoxidil 5% in treatment of alopecia areata: a trichoscopic evaluation. Dermatol Ther. 2017. https://doi.org/10.1111/dth.12437. (Epub 2016 Oct 28).

    Article  PubMed  Google Scholar 

  32. Choi HI, Kang BM, Jang J, Hwang ST, Kwon O. Novel effect of sildenafil on hair growth. Biochem Biophys Res Commun. 2018;505(3):685–91. https://doi.org/10.1016/j.bbrc.2018.09.164. (Epub 2018 Oct 3).

    Article  CAS  PubMed  Google Scholar 

  33. Sarifakioglu E, Degim IT, Gorpelioglu C. Determination of the sildenafil effect on alopecia areata in childhood: An open-pilot comparison study. J Dermatol Treat. 2006;17(4):235–7.

    Article  CAS  Google Scholar 

  34. Borchert M, Bruce S, Wirta D, et al. An evaluation of the safety and efficacy of bimatoprost for eyelash growth in pediatric subjects. Clin Ophthalmol. 2016;10:419–29 (Published 2016 Mar 10).

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Zaheri S, Hughes B. Successful use of bimatoprost in the treatment of alopecia of the eyelashes. Clin Exp Dermatol. 2010;35(4):e161–2.

    Article  CAS  PubMed  Google Scholar 

  36. Li AW, Antaya RJ. Successful treatment of pediatric alopecia areata of the scalp using topical bimatoprost. Pediatr Dermatol. 2016;33(5):e282–3.

    Article  PubMed  Google Scholar 

  37. Mehta JS, Raman J, Gupta N, Thoung D. Cutaneous latanoprost in the treatment of alopecia areata. Eye (Lond). 2003;17(3):444–6.

    Article  CAS  PubMed  Google Scholar 

  38. Bhat S, Handa S, De D. A randomized comparative study of the efficacy of topical latanoprost versus topical betamethasone diproprionate lotion in the treatment of localized alopecia areata. Indian J Dermatol Venereol Leprol. 2021;87(1):42–8.

    Article  PubMed  Google Scholar 

  39. Coronel-Pérez IM, Rodríguez-Rey EM, Camacho-Martínez FM. Latanoprost in the treatment of eyelash alopecia in alopecia areata universalis. J Eur Acad Dermatol Venereol. 2010;24(4):481–5.

    Article  PubMed  Google Scholar 

  40. El-Ashmawy AA, El-Maadawy IH, El-Maghraby GM. Efficacy of topical latanoprost versus minoxidil and betamethasone valerate on the treatment of alopecia areata. J Dermatolog Treat. 2018;29(1):55–64.

    Article  CAS  PubMed  Google Scholar 

  41. Yadav S, Dogra S, Kaur I. An unusual anatomical colocalization of alopecia areata and vitiligo in a child, and improvement during treatment with topical prostaglandin E2. Clin Exp Dermatol. 2009;34(8):e1010–1.

    Article  CAS  PubMed  Google Scholar 

  42. Hill ND, Bunata K, Hebert AA. Treatment of alopecia areata with squaric acid dibutylester. Clin Dermatol. 2015;33(3):300–4.

    Article  PubMed  Google Scholar 

  43. Giannetti A, Orecchia G. Clinical experience on the treatment of alopecia areata with squaric acid dibutyl ester. Dermatologica. 1983;167(5):280–2.

    Article  CAS  PubMed  Google Scholar 

  44. Tosti A, Guidetti MS, Bardazzi F, Misciali C. Long-term results of topical immunotherapy in children with alopecia totalis or alopecia universalis. J Am Acad Dermatol. 1996;35(2 Pt 1):199–201.

    Article  CAS  PubMed  Google Scholar 

  45. Pardasani AG, Turner E, McMichael AJ. Squaric acid dibutylester: indications for use and efficacy in alopecia areata. Arch Dermatol. 2001;137(7):970–2.

    CAS  PubMed  Google Scholar 

  46. Salsberg JM, Donovan J. The safety and efficacy of diphencyprone for the treatment of alopecia areata in children. Arch Dermatol. 2012;148(9):1084–5.

    Article  CAS  PubMed  Google Scholar 

  47. Schuttelaar ML, Hamstra JJ, Plinck EP, et al. Alopecia areata in children: treatment with diphencyprone. Br J Dermatol. 1996;135(4):581–5.

    Article  CAS  PubMed  Google Scholar 

  48. Hull SM, Pepall L, Cunliffe WJ. Alopecia areata in children: response to treatment with diphencyprone. Br J Dermatol. 1991;125(2):164–8.

    Article  CAS  PubMed  Google Scholar 

  49. Orecchia G, Rabbiosi G. Treatment of alopecia areata with diphencyprone. Dermatologica. 1985;171(3):193–6.

    Article  CAS  PubMed  Google Scholar 

  50. Luk NM, Chiu LS, Lee KC, et al. Efficacy and safety of diphenylcyclopropenone among Chinese patients with steroid resistant and extensive alopecia areata. J Eur Acad Dermatol Venereol. 2013;27(3):e400–5.

    Article  CAS  PubMed  Google Scholar 

  51. Singh G, Okade R, Naik C, Dayanand CD. Diphenylcyclopropenone immunotherapy in ophiasis. Indian J Dermatol Venereol Leprol. 2007;73(6):432–3.

    Article  PubMed  Google Scholar 

  52. Sotiriadis D, Patsatsi A, Lazaridou E, Kastanis A, Vakirlis E, Chrysomallis F. Topical immunotherapy with diphenylcyclopropenone in the treatment of chronic extensive alopecia areata. Clin Exp Dermatol. 2007;32(1):48–51.

    CAS  PubMed  Google Scholar 

  53. Orecchia G, Malagoli P. Topical immunotherapy in children with alopecia areata. J Invest Dermatol. 1995;104(5 Suppl):35S-36S.

    Article  CAS  PubMed  Google Scholar 

  54. Durdu M, Özcan D, Baba M, Seçkin D. Efficacy and safety of diphenylcyclopropenone alone or in combination with anthralin in the treatment of chronic extensive alopecia areata: a retrospective case series. J Am Acad Dermatol. 2015;72(4):640–50.

    Article  CAS  PubMed  Google Scholar 

  55. Özdemir M, Balevi A. Bilateral half-head comparison of 1% anthralin ointment in children with alopecia areata. Pediatr Dermatol. 2017;34(2):128–32.

    Article  PubMed  Google Scholar 

  56. Wu SZ, Wang S, Ratnaparkhi R, Bergfeld WF. Treatment of pediatric alopecia areata with anthralin: a retrospective study of 37 patients. Pediatr Dermatol. 2018;35(6):817–20.

    Article  PubMed  Google Scholar 

  57. Torchia D, Schachner LA. Bilateral treatment for alopecia areata. Pediatr Dermatol. 2010;27(4):415–6.

    Article  PubMed  Google Scholar 

  58. Letada PR, Sparling JD, Norwood C. Imiquimod in the treatment of alopecia universalis. Cutis. 2007;79(2):138–40.

    PubMed  Google Scholar 

  59. Wasyłyszyn T, Borowska K. Possible advantage of imiquimod and diphenylcyclopropenone combined treatment versus diphenylcyclopropenone alone: an observational study of nonresponder patients with alopecia areata. Austral J Dermatol. 2017;58(3):219–23.

    Article  Google Scholar 

  60. Bubna AK. Imiquimod - its role in the treatment of cutaneous malignancies. Indian J Pharmacol. 2015;47(4):354–9. https://doi.org/10.4103/0253-7613.161249.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Talpur R, Vu J, Bassett R, Stevens V, Duvic M. Phase I/II randomized bilateral half-head comparison of topical bexarotene 1% gel for alopecia areata. J Am Acad Dermatol. 2009;61(4):592.e1-592.e5929.

    Article  PubMed  Google Scholar 

  62. Jun M, Lee NR, Lee WS. Efficacy and safety of superficial cryotherapy for alopecia areata: A retrospective, comprehensive review of 353 cases over 22 years [published correction appears in J Dermatol. 2017 Aug;44(8):985]. J Dermatol. 2017;44(4):386–93.

  63. Zawar VP, Karad GM. Liquid nitrogen cryotherapy in recalcitrant alopecia areata: a study of 11 patients. Int J Trichol. 2016;8(1):15–20.

    Article  Google Scholar 

  64. Jury CS, McHenry P, Burden AD, Lever R, Bilsland D. Narrowband ultraviolet B (UVB) phototherapy in children. Clin Exp Dermatol. 2006;31(2):196–9.

    Article  CAS  PubMed  Google Scholar 

  65. Al-Mutairi N. 308-nm excimer laser for the treatment of alopecia areata in children. Pediatr Dermatol. 2009;26(5):547–50.

    Article  PubMed  Google Scholar 

  66. Al-Mutairi N. 308-nm excimer laser for the treatment of alopecia areata. Dermatol Surg. 2007;33(12):1483–7.

    Article  CAS  PubMed  Google Scholar 

  67. Zakaria W, Passeron T, Ostovari N, Lacour JP, Ortonne JP. 308-nm excimer laser therapy in alopecia areata. J Am Acad Dermatol. 2004;51(5):837–8.

    Article  PubMed  Google Scholar 

  68. Cho HR, Lew BL, Lew H, Sim WY. Treatment effects of intradermal botulinum toxin type A injection on alopecia areata. Dermatol Surg. 2010;36(Suppl 4):2175–81.

    Article  CAS  PubMed  Google Scholar 

  69. Gallaga NM, Carrillo B, Good A, Munoz-Gonzalez A, Ross L. Pediatric pulse dose corticosteroid therapy dosing and administration in the treatment of alopecia areata: a review of literature. Pediatr Dermatol. 2023;40(2):276–81. https://doi.org/10.1111/pde.15209. (Epub 2022 Dec 2).

    Article  PubMed  Google Scholar 

  70. Jahn-Bassler K, Bauer WM, Karlhofer F, Vossen MG, Stingl G. Sequential high- and low-dose systemic corticosteroid therapy for severe childhood alopecia areata. J Dtsch Dermatol Ges. 2017;15(1):42–7.

    Article  PubMed  Google Scholar 

  71. Lalosevic J, Gajic-Veljic M, Bonaci-Nikolic B, Nikolic M. Combined oral pulse and topical corticosteroid therapy for severe alopecia areata in children: a long-term follow-up study. Dermatol Ther. 2015;28(5):309–17.

    Article  PubMed  Google Scholar 

  72. Chong JH, Taïeb A, Morice-Picard F, Dutkiewicz AS, Léauté-Labrèze C, Boralevi F. High-dose pulsed corticosteroid therapy combined with methotrexate for severe alopecia areata of childhood. J Eur Acad Dermatol Venereol. 2017;31(11):e476–7.

    Article  CAS  PubMed  Google Scholar 

  73. Seiter S, Ugurel S, Tilgen W, Reinhold U. High-dose pulse corticosteroid therapy in the treatment of severe alopecia areata. Dermatology. 2001;202(3):230–4.

    Article  CAS  PubMed  Google Scholar 

  74. Unger WP, Schemmer RJ. Corticosteroids in the treatment of alopecia totalis. Systemic effects. Arch Dermatol. 1978;114(10):1486–90.

    Article  CAS  PubMed  Google Scholar 

  75. Sharma VK, Gupta S. Twice weekly 5 mg dexamethasone oral pulse in the treatment of extensive alopecia areata. J Dermatol. 1999;26(9):562–5.

    Article  CAS  PubMed  Google Scholar 

  76. Smith A, Trüeb RM, Theiler M, Hauser V, Weibel L. High relapse rates despite early intervention with intravenous methylprednisolone pulse therapy for severe childhood alopecia areata. Pediatr Dermatol. 2015;32(4):481–7.

    Article  PubMed  Google Scholar 

  77. Senila SC, Danescu SA, Ungureanu L, Candrea E, Cosgarea RM. Intravenous methylprednisolone pulse therapy in severe alopecia areata. Indian J Dermatol Venereol Leprol. 2015;81(1):95.

    Article  PubMed  Google Scholar 

  78. Hubiche T, Léauté-Labrèze C, Taïeb A, Boralevi F. Poor long term outcome of severe alopecia areata in children treated with high dose pulse corticosteroid therapy. Br J Dermatol. 2008;158(5):1136–7.

    Article  CAS  PubMed  Google Scholar 

  79. Bin Saif GA. Oral mega pulse methylprednisolone in alopecia universalis. Saudi Med J. 2006;27(5):717–20.

    PubMed  Google Scholar 

  80. Friedli A, Labarthe MP, Engelhardt E, Feldmann R, Salomon D, Saurat JH. Pulse methylprednisolone therapy for severe alopecia areata: an open prospective study of 45 patients. J Am Acad Dermatol. 1998;39(4 Pt 1):597–602.

    Article  CAS  PubMed  Google Scholar 

  81. Kiesch N, Stene JJ, Goens J, Vanhooteghem O, Song M. Pulse steroid therapy for children’s severe alopecia areata? Dermatology. 1997;194(4):395–7.

    Article  CAS  PubMed  Google Scholar 

  82. Perriard-Wolfensberger J, Pasche-Koo F, Mainetti C, Labarthe MP, Salomon D, Saurat JH. Pulse of methylprednisolone in alopecia areata. Dermatology. 1993;187(4):282–5.

    Article  CAS  PubMed  Google Scholar 

  83. Kar BR, Handa S, Dogra S, Kumar B. Placebo-controlled oral pulse prednisolone therapy in alopecia areata. J Am Acad Dermatol. 2005;52(2):287–90.

    Article  PubMed  Google Scholar 

  84. Efentaki P, Altenburg A, Haerting J, Zouboulis CC. Medium-dose prednisolone pulse therapy in alopecia areata. Dermatoendocrinol. 2009;1(6):310–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  85. Sharma VK, Muralidhar S. Treatment of widespread alopecia areata in young patients with monthly oral corticosteroid pulse. Pediatr Dermatol. 1998;15(4):313–7.

    Article  CAS  PubMed  Google Scholar 

  86. Winter RJ, Kern F, Blizzard RM. Prednisone therapy for alopecia areata. A follow-up report. Arch Dermatol. 1976;112(11):1549–52.

    Article  CAS  PubMed  Google Scholar 

  87. Friedland R, Tal R, Lapidoth M, Zvulunov A, Ben AD. Pulse corticosteroid therapy for alopecia areata in children: a retrospective study. Dermatology. 2013;227(1):37–44.

    Article  CAS  PubMed  Google Scholar 

  88. Yoshimasu T, Kanazawa N, Yamamoto Y, Furukawa F. Multiple courses of pulse corticosteroid therapy for alopecia areata. J Dermatol. 2016;43(9):1075–7.

    Article  CAS  PubMed  Google Scholar 

  89. Alabdulkareem AS, Abahussein AA, Okoro A. Severe alopecia areata treated with systemic corticosteroids. Int J Dermatol. 1998;37(8):622–4.

    Article  CAS  PubMed  Google Scholar 

  90. Seo J, Lee YI, Hwang S, Zheng Z, Kim DY. Intramuscular triamcinolone acetonide: an undervalued option for refractory alopecia areata. J Dermatol. 2017;44(2):173–9.

    Article  CAS  PubMed  Google Scholar 

  91. Michalowski R, Kuczyńska L. Long-term intramuscular triamcinolone-acetonide therapy in alopecia areata totalis and universalis. Arch Dermatol Res. 1978;261(1):73–6.

    Article  CAS  PubMed  Google Scholar 

  92. Royer M, Bodemer C, Vabres P, et al. Efficacy and tolerability of methotrexate in severe childhood alopecia areata. Br J Dermatol. 2011;165(2):407–10.

    Article  CAS  PubMed  Google Scholar 

  93. Lucas P, Bodemer C, Barbarot S, Vabres P, Royer M, Mazereeuw-Hautier J. Methotrexate in severe childhood alopecia areata: long-term follow-up. Acta Derm Venereol. 2016;96(1):102–3.

    Article  CAS  PubMed  Google Scholar 

  94. Landis ET, Pichardo-Geisinger RO. Methotrexate for the treatment of pediatric alopecia areata. J Dermatol Treat. 2018;29(2):145–8.

    Article  CAS  Google Scholar 

  95. Batalla A, Flórez Á, Abalde T, Vázquez-Veiga H. Methotrexate in alopecia areata: a report of three cases. Int J Trichol. 2016;8(4):188–90.

    Article  Google Scholar 

  96. Siegfried EC, Arkin LM, Chiu YE, Hebert AA, Callen JP, Castelo-Soccio L, Co DO, Cordoro KM, Curran ML, Dalrymple AM, Flohr C, Gordon KB, Hanna D, Irvine AD, Kim S, Kirkorian AY, Lara-Corrales I, Lindstrom J, Paller AS, Reyes M, Begolka WS, Tom WL, Van Voorhees AS, Vleugels RA, Lee LW, Davies OMT, Brandling-Bennett HA. Methotrexate for inflammatory skin disease in pediatric patients: consensus treatment guidelines. Pediatr Dermatol. 2023;40(5):789–808. https://doi.org/10.1111/pde.15327. (Epub 2023 Jun 14).

    Article  PubMed  Google Scholar 

  97. Fiedler-Weiss VC, Rumsfield J, Buys CM, West DP, Wendrow A. Evaluation of oral minoxidil in the treatment of alopecia areata. Arch Dermatol. 1987;123(11):1488–90.

    Article  CAS  PubMed  Google Scholar 

  98. Vañó-Galván S, Pirmez R, Hermosa-Gelbard A, Moreno-Arrones ÓM, Saceda-Corralo D, Rodrigues-Barata R, Jimenez-Cauhe J, Koh WL, Poa JE, Jerjen R, Trindade de Carvalho L, John JM, Salas-Callo CI, Vincenzi C, Yin L, Lo-Sicco K, Waskiel-Burnat A, Starace M, Zamorano JL, Jaén-Olasolo P, Piraccini BM, Rudnicka L, Shapiro J, Tosti A, Sinclair R, Bhoyrul B. Safety of low-dose oral minoxidil for hair loss: a multicenter study of 1404 patients. J Am Acad Dermatol. 2021;84(6):1644-1651. https://doi.org/10.1016/j.jaad.2021.02.054. Epub 2021 Feb 24.

  99. Ahmad A, Zaheer M, Balis FJ. Baricitinib—StatPearls—NCBI Bookshelf. Baricitinib. 2022. https://www.ncbi.nlm.nih.gov/books/NBK572064/. Accessed 12 Sept 2023.

  100. Ramírez-Marín HA, Tosti A. Evaluating the therapeutic potential of ritlecitinib for the treatment of alopecia areata. Drug Des Dev Ther. 2022;16:363–74. https://doi.org/10.2147/dddt.s334727.

    Article  CAS  Google Scholar 

  101. Zarrin AA, Bao K, Lupardus P, Vucic D. Kinase inhibition in autoimmunity and inflammation. Nat Rev Drug Discov. 2021;20(1):39–63. https://doi.org/10.1038/s41573-020-0082-8. (Epub 2020 Oct 19).

    Article  CAS  PubMed  Google Scholar 

  102. King B, Zhang X, Harcha WG, et al. Efficacy and safety of ritlecitinib in adults and adolescents with alopecia areata: a randomised, double-blind, multicentre, phase 2b-3 trial [published correction appears in Lancet. 2023 Jun 10;401(10392):1928]. Lancet. 2023;401(10387):1518–29.

  103. Hordinsky M, Hebert AA, Gooderham M, Kwon O, Murashkin N, Fang H, Harada K, Law E, Wajsbrot D, Takiya L, Zwillich SH, Wolk R, Tran H. Efficacy and safety of ritlecitinib in adolescents with alopecia areata: Results from the ALLEGRO phase 2b/3 randomized, double-blind, placebo-controlled trial. Pediatr Dermatol. 2023. https://doi.org/10.1111/pde.15378. (Epub ahead of print).

    Article  PubMed  Google Scholar 

  104. Jabbari A, Dai Z, Xing L, et al. Reversal of alopecia areata following treatment with the JAK1/2 Inhibitor baricitinib. EBioMedicine. 2015;2(4):351–5 (Published 2015 Feb 26).

    Article  PubMed  PubMed Central  Google Scholar 

  105. Craiglow BG, Liu LY, King BA. Tofacitinib for the treatment of alopecia areata and variants in adolescents. J Am Acad Dermatol. 2017;76(1):29–32.

    Article  CAS  PubMed  Google Scholar 

  106. Castelo-Soccio L. Experience with oral tofacitinib in 8 adolescent patients with alopecia universalis. J Am Acad Dermatol. 2017;76(4):754–5.

    Article  PubMed  Google Scholar 

  107. Kibbie J, Kines K, Norris D, Dunnick CA. Oral tofacitinib for the treatment of alopecia areata in pediatric patients. Pediatr Dermatol. 2022;39(1):31–4.

    Article  PubMed  Google Scholar 

  108. Craiglow BG, King BA. Tofacitinib for the treatment of alopecia areata in preadolescent children. J Am Acad Dermatol. 2019;80(2):568–70.

    Article  CAS  PubMed  Google Scholar 

  109. Dai YX, Chen CC. Tofacitinib therapy for children with severe alopecia areata. J Am Acad Dermatol. 2019;80(4):1164–6.

    Article  PubMed  Google Scholar 

  110. Brown L, Skopit S. An excellent response to tofacitinib in a pediatric alopecia patient: a case report and review. J Drugs Dermatol. 2018;17(8):914–7.

    PubMed  Google Scholar 

  111. Patel NU, Oussedik E, Grammenos A, Pichardo-Geisinger R. A case report highlighting the effective treatment of alopecia universalis with tofacitinib in an adolescent and adult patient. J Cutan Med Surg. 2018;22(4):439–42.

    Article  PubMed  Google Scholar 

  112. Liu LY, King BA. Response to tofacitinib therapy of eyebrows and eyelashes in alopecia areata. J Am Acad Dermatol. 2019;80(6):1778–9.

    Article  PubMed  Google Scholar 

  113. Berbert Ferreira R, Ferreira SB, Scheinberg MA. An excellent response to tofacitinib in a Brazilian adolescent patient with alopecia areata: a case report and a review of the literature. Clin Case Rep. 2019;7(12):2539–42 (Published 2019 Nov 21).

    Article  PubMed  PubMed Central  Google Scholar 

  114. Dincer Rota D, Emeksiz MAC, Erdogan FG, Yildirim D. Experience with oral tofacitinib in severe alopecia areata with different clinical responses. J Cosmet Dermatol. 2021;20(9):3026–33.

    Article  PubMed  Google Scholar 

  115. Jerjen R, Meah N, de Carvalho LT, Wall D, Eisman S, Sinclair R. Treatment of alopecia areata in pre-adolescent children with oral tofacitinib: a retrospective study. Pediatr Dermatol. 2021;38(1):103–8.

    Article  PubMed  Google Scholar 

  116. Akdogan N, Ersoy-Evans S, Doğan S, Atakan N. Experience with oral tofacitinib in two adolescents and seven adults with alopecia areata. Dermatol Ther. 2019;32(6): e13118.

    Article  PubMed  Google Scholar 

  117. Liu LY, King BA. Ruxolitinib for the treatment of severe alopecia areata. J Am Acad Dermatol. 2019;80(2):566–8.

    Article  PubMed  Google Scholar 

  118. McKenzie PL, Castelo-Soccio L. Dupilumab therapy for alopecia areata in pediatric patients with concomitant atopic dermatitis. J Am Acad Dermatol. 2021;84(6):1691–4.

    Article  PubMed  Google Scholar 

  119. Benson JM, Peritt D, Scallon BJ, Heavner GA, Shealy DJ, Giles-Komar JM, Mascelli MA. Discovery and mechanism of ustekinumab. MAbs. 2011;3(6):535–45. https://doi.org/10.4161/mabs.3.6.17815.

    Article  PubMed  PubMed Central  Google Scholar 

  120. Aleisa A, Lim Y, Gordon S, et al. Response to ustekinumab in three pediatric patients with alopecia areata. Pediatr Dermatol. 2019;36(1):e44–5.

    Article  PubMed  Google Scholar 

  121. Skurkovich S, Korotky NG, Sharova NM, Skurkovich B. Treatment of alopecia areata with anti-interferon-gamma antibodies. J Investig Dermatol Symp Proc. 2005;10(3):283–4.

    Article  CAS  PubMed  Google Scholar 

  122. Liu LY, King BA. Lack of efficacy of apremilast in 9 patients with severe alopecia areata. J Am Acad Dermatol. 2017;77(4):773–4.

    Article  PubMed  Google Scholar 

  123. Kim BJ, Min SU, Park KY, et al. Combination therapy of cyclosporine and methylprednisolone on severe alopecia areata. J Dermatolog Treat. 2008;19(4):216–20.

    Article  CAS  PubMed  Google Scholar 

  124. Gensure RC. Clinical response to combined therapy of cyclosporine and prednisone. J Investig Dermatol Symp Proc. 2013;16(1):S58.

    Article  CAS  PubMed  Google Scholar 

  125. Farhangian ME, McMichael AJ, Huang KE, Feldman SR. Treatment of alopecia areata in the United States: a retrospective cross-sectional study. J Drugs Dermatol. 2015;14(9):1012–4.

    CAS  PubMed  Google Scholar 

  126. Price VH, Willey A, Chen BK. Topical tacrolimus in alopecia areata. J Am Acad Dermatol. 2005;52(1):138–9.

    Article  PubMed  Google Scholar 

  127. Thiers BH. Topical tacrolimus: treatment failure in a patient with alopecia areata. Arch Dermatol. 2000;136(1):124.

    Article  CAS  PubMed  Google Scholar 

  128. Jung KE, Gye JW, Park MK, Park BC. Comparison of the topical FK506 and clobetasol propionate as first-line therapy in the treatment of early alopecia areata. Int J Dermatol. 2017;56(12):1487–8.

    Article  PubMed  Google Scholar 

  129. Sauerbrey A. Successful immunsuppression in childhood alopecia areata. Klin Padiatr. 2011;223(4):244–5.

    Article  CAS  PubMed  Google Scholar 

  130. Rashidi T, Mahd AA. Treatment of persistent alopecia areata with sulfasalazine. Int J Dermatol. 2008;47(8):850–2.

    Article  PubMed  Google Scholar 

  131. Bakar O, Gurbuz O. Is there a role for sulfasalazine in the treatment of alopecia areata? J Am Acad Dermatol. 2007;57(4):703–6.

    Article  PubMed  Google Scholar 

  132. Aghaei S. An uncontrolled, open label study of sulfasalazine in severe alopecia areata. Indian J Dermatol Venereol Leprol. 2008;74(6):611–3.

    Article  PubMed  Google Scholar 

  133. Yun D, Silverberg NB, Stein SL. Alopecia areata treated with hydroxychloroquine: a retrospective study of nine pediatric cases. Pediatr Dermatol. 2018;35(3):361–5.

    Article  PubMed  Google Scholar 

  134. Mitchell AJ, Douglass MC. Topical photochemotherapy for alopecia areata. J Am Acad Dermatol. 1985;12(4):644–9.

    Article  CAS  PubMed  Google Scholar 

  135. Majumdar B, De A, Ghosh S, et al. “Turban PUVAsol:” a simple, novel, effective, and safe treatment option for advanced and refractory cases of alopecia areata. Int J Trichol. 2018;10(3):124–8.

    Article  Google Scholar 

  136. Yoon TY, Kim YG. Infant alopecia universalis: role of topical PUVA (psoralen ultraviolet A) radiation. Int J Dermatol. 2005;44(12):1065–7.

    Article  PubMed  Google Scholar 

  137. Claudy AL, Gagnaire D. PUVA treatment of alopecia areata. Arch Dermatol. 1983;119(12):975–8.

    Article  CAS  PubMed  Google Scholar 

  138. El-Mofty M, Rasheed H, El-Eishy N, et al. A clinical and immunological study of phototoxic regimen of ultraviolet A for treatment of alopecia areata: a randomized controlled clinical trial. J Dermatol Treat. 2019;30(6):582–7.

    Article  CAS  Google Scholar 

  139. Amer MA, El Garf A. Photochemotherapy and alopecia areata. Int J Dermatol. 1983;22(4):245–6.

    Article  CAS  PubMed  Google Scholar 

  140. Boonyaleepun S, Boonyaleepun C, Schlactus JL. Effect of IVIG on the hair regrowth in a common variable immune deficiency patient with alopecia universalis. Asian Pac J Allergy Immunol. 1999;17(1):59–62.

    CAS  PubMed  Google Scholar 

  141. Teshima H, Sogawa H, Mizobe K, Kuroki N, Nakagawa T. Application of psychoimmunotherapy in patients with alopecia universalis. Psychother Psychosom. 1991;56(4):235–41.

    Article  CAS  PubMed  Google Scholar 

  142. Toma DM, Atallah RB, Eldahshan RM. Comparative study between topical methotrexate 1% gel and minoxidil 5% gel in the treatment of localized alopecia areata. Dermatol Ther. 2022;35(9): e15696.

    Article  CAS  PubMed  Google Scholar 

  143. Anuset D, Perceau G, Bernard P, Reguiai Z. Efficacy and safety of methotrexate combined with low- to moderate-dose corticosteroids for severe alopecia areata. Dermatology. 2016;232(2):242–8.

    Article  CAS  PubMed  Google Scholar 

  144. Hammerschmidt M, Mulinari BF. Efficacy and safety of methotrexate in alopecia areata. An Bras Dermatol. 2014;89(5):729–34.

    Article  PubMed  PubMed Central  Google Scholar 

  145. Droitcourt C, Milpied B, Ezzedine K, et al. Interest of high-dose pulse corticosteroid therapy combined with methotrexate for severe alopecia areata: a retrospective case series. Dermatology. 2012;224(4):369–73.

    Article  CAS  PubMed  Google Scholar 

  146. Olsen EA, Carson SC, Turney EA. Systemic steroids with or without 2% topical minoxidil in the treatment of alopecia areata. Arch Dermatol. 1992;128(11):1467–73.

    Article  CAS  PubMed  Google Scholar 

  147. Sethuraman G, Malhotra AK, Sharma VK. Alopecia universalis in Down syndrome: response to therapy. Indian J Dermatol Venereol Leprol. 2006;72(6):454–5.

    Article  PubMed  Google Scholar 

  148. Kiszewski AE, Bevilaqua M, De Abreu LB. Mesalazine in the treatment of extensive alopecia areata: a new therapeutic option? Int J Trichology. 2018;10(3):99–102.

    Article  PubMed  PubMed Central  Google Scholar 

  149. Sardana K, Gupta A, Gautam RK. Recalcitrant alopecia areata responsive to leflunomide and anthralin-Potentially undiscovered JAK/STAT inhibitors? Pediatr Dermatol. 2018;35(6):856–8.

    Article  PubMed  Google Scholar 

  150. Das S, Ghorami RC, Chatterjee T, Banerjee G. Comparative assessment of topical steroids, topical tretenoin (0.05%) and dithranol paste in alopecia areata. Indian J Dermatol. 2010;55(2):148–9.

    Article  PubMed  PubMed Central  Google Scholar 

  151. Yoham AL, Casadesus D. Tretinoin—StatPearls—NCBI Bookshelf. 2023. https://www.ncbi.nlm.nih.gov/books/NBK557478/. Accessed 12 Sept 2023.

  152. Mahgoub D, Mohye Eldeen R, Saadi D, El-Samanoudy S, Ibrahim S. Clinical and trichoscopic evaluation of trichloroacetic acid 35% vs phenol 88% peels in treatment of alopecia areata. J Cosmet Dermatol. 2021;20(1):143–9.

    Article  PubMed  Google Scholar 

  153. Camacho FM, García-Hernández MJ. Zinc aspartate, biotin, and clobetasol propionate in the treatment of alopecia areata in childhood. Pediatr Dermatol. 1999;16(4):336–8.

    Article  CAS  PubMed  Google Scholar 

  154. Lux-Battistelli C. Combination therapy with zinc gluconate and PUVA for alopecia areata totalis: an adjunctive but crucial role of zinc supplementation. Dermatol Ther. 2015;28(4):235–8.

    Article  PubMed  Google Scholar 

  155. Fenniche S, Hammami H, Zaouak A. Association of khellin and 308-nm excimer lamp in the treatment of severe alopecia areata in a child. J Cosmet Laser Ther. 2018;20(3):156–8.

    Article  PubMed  Google Scholar 

  156. Clinical Trials. National Library of Medicine. http://www.clinicaltrials.gov. Accessed 12 Sept 2023.

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  1. School of Medicine, University of North Carolina, Chapel Hill, NC, USA

    Linnea L. Westerkam

  2. Department of Dermatology, University of North Carolina, Chapel Hill, NC, USA

    Diana B. McShane, Elizabeth L. Nieman & Dean S. Morrell

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Westerkam, L.L., McShane, D.B., Nieman, E.L. et al. Treatment Options for Alopecia Areata in Children and Adolescents. Pediatr Drugs (2024). https://doi.org/10.1007/s40272-024-00620-2

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