Department of Dermatology, Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
J Dermatol. 2017 Nov;44(11):1199-1211. doi: 10.1111/1346-8138.13933. Epub 2017 Jun 21.
Alopecia areata is a chronic, recurrent and non-scarring alopecia. The prognoses of patients are very diverse. The larger the area of hair loss, the poorer the treatment response and greater the probability of chronic disease progression. Numerous treatments have been introduced, but curative treatments have yet to be established. The long-term efficacy of the current treatments is minimal, and the therapeutic response varies widely. Recent clinical trials have attempted to apply therapeutic metrics, such as the Severity of Alopecia Tool, and many have been designed as randomized controlled studies, enabling a more precise evaluation of existing treatments. There have been updates in practice, efficacy or indications of therapeutics that have been previously used. Moreover, the use of novel treatments such as biologics has recently been introduced. Commonly, the most important factor in determining the treatment modality for alopecia areata has been the extent of hair loss. However, if the disease activity is high and likely to progress, combination therapy with adjuvant modalities will be more desirable. This review will discuss the therapeutic effects of existing and newly-introduced treatments based on their quantity, quality of evidence and expected complications. In addition, an algorithmic approach to management of alopecia areata is proposed according to clinical subtype, severity, onset and activity of the disease.
斑秃是一种慢性、复发性、非瘢痕性脱发。患者的预后差异很大。脱发面积越大，治疗反应越差，疾病进展为慢性的可能性越大。已经引入了许多治疗方法，但尚未确立治愈方法。目前治疗的长期疗效有限，治疗反应差异很大。最近的临床试验试图应用治疗指标，如脱发严重程度评估工具，许多研究设计为随机对照研究，从而能够更精确地评估现有治疗方法。以前使用的治疗药物的疗效或适应证有了更新。此外，最近还引入了新型治疗方法，如生物制剂。通常，决定斑秃治疗方式的最重要因素是脱发的程度。然而，如果疾病活动度高且可能进展，联合辅助治疗模式将更为理想。本综述将根据现有的和新引入的治疗方法的数量、证据质量和预期并发症，讨论其治疗效果。此外，根据临床亚型、严重程度、发病和疾病活动度，提出了斑秃管理的算法方法。
