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Published on: March 9, 2015
Treatment of pediatric alopecia areata: A systematic review
Virginia R Barton1, Atrin Toussi1, Smita Awasthi2
1Department of Dermatology, University of California Davis, Sacramento, California.
Insights
Topical corticosteroids are the preferred first-line treatment for pediatric alopecia areata (AA), offering the highest evidence level. Further research is needed to guide management and explore novel therapies for this autoimmune hair loss condition.
Area of Science:
- Dermatology
- Pediatric Autoimmune Disorders
Background:
- Alopecia areata (AA) is an autoimmune, nonscarring hair loss disorder.
- Pediatric AA has a slightly greater prevalence than in adults.
- Evidence for current treatment modalities in pediatric AA is lacking.
Purpose of the Study:
- To evaluate the evidence of current treatment modalities for pediatric alopecia areata.
Main Methods:
- Systematic review of PubMed database in October 2019.
- Included articles published on patients under 18 years old.
- 122 reports discussing 1032 pediatric patients were analyzed.
Main Results:
- Included 1032 pediatric patients across 122 reports.
- Evaluated treatments included corticosteroids, contact immunotherapy, Janus kinase inhibitors, and others.
- Topical corticosteroids and contact immunotherapy showed the highest evidence levels.
Conclusions:
- Topical corticosteroids are the preferred first-line treatment for pediatric AA.
- Contact immunotherapy is a viable second-line option.
- More clinical trials are needed for pediatric AA management, including novel therapies like Janus kinase inhibitors.
Background:
Alopecia areata (AA) is an autoimmune, nonscarring hair loss disorder with slightly greater prevalence in children than adults. Various treatment modalities exist; however, their evidence in pediatric AA patients is lacking.
Objective:
To evaluate the evidence of current treatment modalities for pediatric AA.
Methods:
We conducted a systematic review on the PubMed database in October 2019 for all published articles involving patients <18 years old. Articles discussing AA treatment in pediatric patients were included, as were articles discussing both pediatric and adult patients, if data on individual pediatric patients were available.
Results:
Inclusion criteria were met by 122 total reports discussing 1032 patients. Reports consisted of 2 randomized controlled trials, 4 prospective comparative cohorts, 83 case series, 2 case-control studies, and 31 case reports. Included articles assessed the use of aloe, apremilast, anthralin, anti-interferon gamma antibodies, botulinum toxin, corticosteroids, contact immunotherapies, cryotherapy, hydroxychloroquine, hypnotherapy, imiquimod, Janus kinase inhibitors, laser and light therapy, methotrexate, minoxidil, phototherapy, psychotherapy, prostaglandin analogs, sulfasalazine, topical calcineurin inhibitors, topical nitrogen mustard, and ustekinumab.
Limitations:
English-only articles with full texts were used. Manuscripts with adult and pediatric data were only incorporated if individual-level data for pediatric patients were provided. No meta-analysis was performed.
Conclusion:
Topical corticosteroids are the preferred first-line treatment for pediatric AA, as they hold the highest level of evidence, followed by contact immunotherapy. More clinical trials and comparative studies are needed to further guide management of pediatric AA and to promote the potential use of pre-existing, low-cost, and novel therapies, including Janus kinase inhibitors.
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