Consensus-Based Guidance on Management of Alopecia Areata

Bald spot on the scalp of a child due to alopecia areata.
Although consensus was achieved on a number of alopecia areata treatment topics, the survey also revealed areas in which expert consensus is lacking.

Findings from a Delphi survey of the Alopecia Areata Consensus of Experts have provided general consensus statements on the management of alopecia areata (AA), which may guide future guidance statements. The findings from this survey were reported in the Journal of the American Academy of Dermatology.

A total of 50 hair experts from the Australia, the Middle East, United Kingdom, continental Europe, and North America participated in a 3-round Delphi process. The Delphi survey consisted of questions supported by a literature review that covered epidemiology, etiopathogenesis, diagnosis, investigation, treatment, and prognosis of AA. There were 2 questionnaire rounds followed by a face-to-face meeting at the 11th World Congress for Hair Research (WCHR) in Barcelona, Spain. Consensus was defined as agreement of ≥66%.

Approximately 60% (n=30) of the original 50-person committee completed rounds 1 and 2 and attended the face-to-face meeting. Categories with the greatest consensus included intralesional treatment of AA (68%) and topical treatment of AA (43%). In terms of intralesional treatment, consensus was achieved in relation to optimal dosage and administration and complications of treatment. For topical therapy, consensus was achieved in questions that addressed choice, duration, assessment of efficacy, and application site. Phototherapy and nonprescription therapies achieved the least consensus.

The expert committee did achieve consensus in 36% of questions posed for systemic therapies in AA. These therapies include systemic corticosteroids, ciclosporin, methotrexate, and azathioprine. In addition, consensus was reached in 50% of questions that discussed appropriate timing of systemic treatment discontinuation. The committee suggests that discontinuation should occur once complete regrowth has been achieved and maintained for approximately 6 months.

Although the study included a substantial number of skin-directed and systemic therapies for AA, not all these treatments were addressed in the questionnaire.

Findings from this survey highlight that the Alopecia Areata Consensus of Experts can provide “a framework to build consensus on treatment of AA through the identification of evidence gaps,” it was noted.

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Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Meah N, Wall D, York K, et al. The alopecia areata consensus of experts (ACE) study: results of an international expert opinion on treatments for alopecia areata [published online March 9, 2020]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2020.03.004