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Year : 2019  |  Volume : 4  |  Issue : 2  |  Page : 78-82

Severe alopecia areata: Analysis of treatment outcome

1 Department of Dermatology, College of Medicine, Al-Imam Mohammed Bin Saud Islamic University; Aesthetica Clinics, Riyadh, Saudi Arabia
2 Department of Medicine, Imam Abdulrahman Al Faisal Hospital; Derma Clinics, Riyadh, Saudi Arabia

Correspondence Address:
Dr. Thamer Mubki
PO Box 230244, Riyadh 11321
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijas.ijas_13_19

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Problem Statement: Data on treatment options in severe alopecia areata (AA) are limited. All available therapies are currently off-label. Choosing the best therapy could be challenging. Materials and Methods: Medical records of a cohort of 55 patients with severe AA, involving >40% of scalp, including totalis and universalis who were started on topical or systemic therapy, were reviewed for efficacy and safety data. Response to therapy was evaluated using changes in the validated Severity of Alopecia Tool (SALT). SALT50 was defined as 50% regrowth and was regarded as a treatment success. Results: Thirty-two patients met the study inclusion criteria. Mean treatment duration was 11.4 months. 78% of patients had AA for >1 year. 41% had AA totalis/universalis. 53% achieved SAL50 using the described treatments. However, only 38% of AA totalis/universalis achieved SALT 50 as compared to 62% of patchy type (P = 0.148). SALT50 was achieved in 27% of patients using anthralin, 30% with diphenylcyclopropenone acetate, 28% with intralesional steroid injection, and 56% using tofacitinib. 55% of patients who used minoxidil 5% achieved SALT50 compared to only 40% of those who did not use it (P = 0.026). Conclusions: Treatment of severe AA is possible. More than 50% of cases may respond to therapy. AA totalis/universalis may, however, respond less favorably than the patchy type. Tofacitinib, and possibly other Janus kinase inhibitors, is very promising therapies for severe cases. Minoxidil 5% solution was significantly associated with better response to therapies in severe AA cases.

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