S3 guideline diagnostics and therapy in alopecia areata - Part 2: Therapy, psychosocial and cosmetic support

This second part of the S3 guideline on the diagnosis and treatment of alopecia areata (AA), presents key recommendations on topical and systemic therapy, quality of life and support services. The first part of the guideline, published separately, covers the definition and content of epidemiology and diagnosis as well as comorbidities, risk and prognostic factors. The application of corticosteroids is the only topical intervention with a high level of recommendation. All other topical agents that can be offered for the treatment of AA have a low level of recommendation, whereby the recommendation levels for the individual topical agents vary in the age groups of children, adolescents and adults. Of the active substances for systemic treatment of AA, only systemic corticosteroids and Janus kinase inhibitors (JAK) have a high level of recommendation, and they are restricted only to adults. Children and adolescents can be offered corticosteroids, methotrexate or JAK* (*with appropriate authorisation for the age group) for a severe form or higher. All other systemic agents should not be offered to children and adolescents. The expert group recommends that all patients with all forms of AA, regardless of age, should be informed about the possibilities of hair replacement and cosmetic options.