Current Management and Unmet Needs in Alopecia Areata: Viewpoint From a Malaysian Perspective

Alopecia areata (AA) is a chronic, immune-mediated disease characterized by nonscarring hair loss and a substantial clinical and psychosocial burden, yet it is still widely perceived as a purely cosmetic concern. In this viewpoint, we draw on the available Malaysian studies, selected international evidence, and our collective clinical experience to propose that AA warrants greater clinical, research, and policy attention in Malaysia. Malaysia-specific evidence remains limited and is derived largely from retrospective, single-center studies; nonetheless, the available data point to variable disease presentation, inconsistent use of standardized severity assessment, reliance on conventional therapies, substantial loss to follow-up, and a meaningful psychosocial impact among affected patients. Current local management appears to rely mainly on conventional therapies, while access to advanced therapies such as Janus kinase inhibitors remains constrained by affordability and reimbursement challenges. We therefore call for 5 priorities: strengthening Malaysia-specific epidemiological and real-world evidence, including through a national AA registry; adopting standardized disease-assessment tools in clinical studies and routine practice; integrating psychosocial support into AA care pathways; developing locally relevant clinical guidance; and improving public, clinician, and policymaker awareness that AA is a medical condition rather than a cosmetic concern. Together, these steps would support earlier diagnosis, more equitable access to effective treatment, and holistic, patient-centered care for adults and children living with AA in Malaysia.