Advances in the management of alopecia areata

Spontaneous remission occurs in up to 80% of patients with limited patchy alopecia areata (AA) within 1 year. Therefore, not all patients of AA simplex/multiplex need extensive treatments, and "wait and see" is one of the choices for some patients. However, once the hair loss show progressive course, it is really difficult to manage well and may be recalcitrant to any treatment in some cases. Hair loss symptom is not life-threatening but severely decreases quality of life. There have been two widely known guidelines for AA from the British Association of Dermatologists and the National Alopecia Areata Foundation (USA). These guidelines have been substantial and provide clues for dermatologists but needed to be updated. Recently, the Japanese Dermatological Association also published a guideline for the management of AA. This guideline suggests treatments followed by recommendations and evidence levels. Several new treatments are added such as corticosteroid pulse therapy and antihistamine drugs in addition to Japanese historical therapies. Although the highly recommended therapies are still contact immunotherapy and local injection of corticosteroid, it may result in improvement of AA by use of appropriate treatments decided by age, hair loss type, disease course and desire of the AA patient.