Systemic Therapies for Pediatric Alopecia Areata

Alopecia areata (AA) is an autoimmune hair loss disorder that commonly affects children. While mild disease may improve spontaneously or with topical therapies, patients with more extensive involvement typically require systemic treatment. This narrative review examines the literature describing systemic therapies for pediatric AA. High-quality evidence is extremely limited, with the majority of evidence coming from case reports and series. Janus kinase inhibitors are the only class of medications with systematic data supporting their use. There are an increasing number of reports suggesting that oral minoxidil may be beneficial, especially as an adjunctive treatment. Some patients with AA and comorbid atopy may benefit from treatment with dupilumab. Systemic corticosteroids may provide initial improvement, but the risk for adverse effects precludes long-term use, and efficacy is often lost once discontinued. There is very little literature to support the use of traditional immunomodulatory medicines such as methotrexate, cyclosporine, and azathioprine.