S3 Guideline Diagnostics and Therapy in Alopecia Areata – Part 2: Therapy, Psychosocial and Cosmetic Support

May 2026 in “ JDDG Journal der Deutschen Dermatologischen Gesellschaft ”

Ulrike Blume‐Peytavi, Andria Constantinou, Tsenka Tomova‐Simitchieva, Adrian Tanew, Michael Sticherling, H Girschick, Annika Vogt, Uwe Schwichtenberg, Uwe Gieler, André Märtens, Kerstin Zienert, Claudia Stenders, Ricardo Niklas Werner, Doris Wilborn

alopecia areata topical corticosteroids systemic corticosteroids Janus kinase inhibitors JAK methotrexate hair replacement cosmetic options AA JAK inhibitors

TLDR Use topical corticosteroids for alopecia areata, consider systemic treatments like corticosteroids or JAK inhibitors for severe cases, and inform about cosmetic options.

The S3 guideline on alopecia areata (AA) provides recommendations for therapy and support. Topical corticosteroids are highly recommended, while other topical treatments have lower recommendations, varying by age group. For systemic treatment, only corticosteroids and Janus kinase inhibitors (JAK) are highly recommended for adults, with children and adolescents being offered corticosteroids, methotrexate, or JAK for severe cases. All patients should be informed about hair replacement and cosmetic options.

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research British Association of Dermatologists Living Guideline for Managing People with Alopecia Areata 2024

20 citations , October 2024 in “British Journal of Dermatology”

The guideline provides recommendations for managing alopecia areata effectively.

research European Expert Consensus Statement on the Systemic Treatment of Alopecia Areata

4 citations , January 2024 in “JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology”

Baricitinib and ritlecitinib are recommended for severe alopecia areata, with other treatments available off-label.

research Clinical Benefits of Baricitinib Therapy for Severe Alopecia Areata

November 2023 in “Dermatology and Therapy”

Baricitinib treatment helps regrow eyebrow, eyelash, and scalp hair in severe alopecia areata, improving patients' emotional well-being and quality of life.

research Treatments for Moderate-to-Severe Alopecia Areata: A Systematic Narrative Review

1 citations , October 2023 in “Dermatology and therapy”

Some treatments for severe hair loss work but often have side effects, with baricitinib showing the most promise.

research Diphenylcyclopropenone and Platelet-Rich Plasma in the Management of Severe or Recalcitrant Alopecia Areata

June 2023 in “Journal of cosmetic dermatology”

Both DPCP alone and with PRP are effective and safe for treating severe alopecia areata.

research The Evaluation of JAK Inhibitors on Effect and Safety in Alopecia Areata: A Systematic Review and Meta-Analysis of 2018 Patients

4 citations , June 2023 in “Frontiers in immunology”

JAK inhibitors help hair regrowth in alopecia areata but have a high risk of side effects.

research Safety of Janus Kinase Inhibitors in Patients with Alopecia Areata: A Systematic Review

3 citations , May 2023 in “Clinical drug investigation”

JAK inhibitors for alopecia areata are linked to minor side effects like headache and acne, but not to an increased risk of serious adverse events.

research Efficacy and Safety of Different JAK Inhibitors in the Treatment of Alopecia Areata: A Network Meta-Analysis

7 citations , April 2023 in “Frontiers in immunology”

Oral baricitinib and ruxolitinib are effective and safe for treating alopecia areata.

research Efficacy and Safety of Ritlecitinib in Adults and Adolescents With Alopecia Areata: A Randomised, Double-Blind, Multicentre, Phase 2b–3 Trial

227 citations , April 2023 in “The Lancet”

Ritlecitinib effectively treats alopecia areata and is well-tolerated.

research Dupilumab in Inflammatory Skin Diseases: A Systematic Review

72 citations , March 2023 in “Biomolecules”

Dupilumab effectively treats various inflammatory skin diseases beyond its initial use for atopic dermatitis.

research Efficacy and Safety of Baricitinib in Patients with Severe Alopecia Areata Over 52 Weeks in Phase III Trials

20 citations , March 2023 in “American Journal of Clinical Dermatology”

Baricitinib improved severe hair loss in adults over 52 weeks and was safe to use.

research Laser and Light Therapy Combined With Topical Minoxidil for Alopecia Areata: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

February 2023 in “Lasers in Medical Science”

research Combined Microneedling With Topical Vitamin D3 or Bimatoprost Versus Microneedling Alone in the Treatment of Alopecia Areata: A Comparative Randomized Trial

February 2023 in “Journal of Cosmetic Dermatology”

Combining microneedling with either vitamin D3 or bimatoprost improves hair regrowth more than microneedling alone.

research Effect of Fractional Laser Alone or in Combination on Alopecia Areata: A Systematic Review and Meta-Analysis

January 2023 in “Journal of cosmetic dermatology”

Fractional lasers effectively treat alopecia areata, especially when combined with minoxidil or cortisol.

research Systematic Review of Psychological Interventions for Quality of Life, Mental Health, and Hair Growth in Alopecia Areata and Scarring Alopecia

29 citations , January 2023 in “Journal of Clinical Medicine”

Psychological interventions can improve mental health and quality of life in people with alopecia.

research Comparative Efficacy and Safety of Janus Kinase Inhibitors Used in Alopecia Areata: A Systematic Review and Meta-Analysis

10 citations , January 2023 in “Acta dermato-venereologica”

Baricitinib and deuruxolitinib are effective for treating alopecia areata, but their efficacy depends on the dose.

research Quality of Life in Children and Adolescents With Alopecia Areata: A Systematic Review

39 citations , January 2023 in “Journal of the European Academy of Dermatology and Venereology”

Alopecia areata significantly worsens quality of life in children, causing embarrassment and social issues.

Comparative Evaluation of the Efficacy of Topical Tacrolimus 0.03% and Topical Calcipotriol 0.005% Mixed With Betamethasone Dipropionate Versus Topical Clobetasol 0.05% in Treatment of Alopecia Areata: A Clinical and Trichoscopic Study

research Comparative Evaluation of the Efficacy of Topical Tacrolimus 0.03% and Topical Calcipotriol 0.005% Mixed With Betamethasone Dipropionate Versus Topical Clobetasol 0.05% in Treatment of Alopecia Areata: A Clinical and Trichoscopic Study

1 citations , December 2022 in “Journal of cosmetic dermatology”

The combination of vitamin D analogues with potent steroids is a favorable treatment for alopecia areata with fewer side effects.

Systematic Review of Newer Agents for the Management of Alopecia Areata in Adults: Janus Kinase Inhibitors, Biologics and Phosphodiesterase-4 Inhibitors

research Systematic Review of Newer Agents for the Management of Alopecia Areata in Adults: Janus Kinase Inhibitors, Biologics and Phosphodiesterase-4 Inhibitors

12 citations , December 2022 in “JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology”

New oral treatments for adult hair loss show promise, especially JAK inhibitors, with mild side effects.

research Platelet-Rich Plasma in Alopecia Areata and Primary Cicatricial Alopecias: A Systematic Review

November 2022 in “Frontiers in Medicine”

PRP shows promise for treating mild alopecia areata but needs more research for cicatricial alopecias.

research Comparative Study Between Intralesional Injection of Platelet Rich Plasma and Triamcinolone for the Treatment of Alopecia Areata

September 2022 in “Journal of Ayub Medical College Abbottabad”

Steroid injections are more effective than platelet rich plasma for treating patchy hair loss.

Evaluation of Fractional Carbon Dioxide Laser Alone Versus Its Combination With Betamethasone Valerate in Treatment of Alopecia Areata: A Clinical and Dermoscopic Study

research Evaluation of Fractional Carbon Dioxide Laser Alone Versus Its Combination With Betamethasone Valerate in Treatment of Alopecia Areata: A Clinical and Dermoscopic Study

3 citations , September 2022 in “Archives of dermatological research”

The fractional carbon dioxide laser is a safe and effective treatment for alopecia areata and works better than betamethasone valerate cream alone.

research The Efficacy and Safety of JAK Inhibitors for Alopecia Areata: A Systematic Review and Meta-Analysis of Prospective Studies

37 citations , August 2022 in “Frontiers in pharmacology”

Oral JAK inhibitors are effective and safe for treating alopecia areata but may need ongoing use to keep results.

research Analysis of Alopecia Areata Surveys Suggests a Threshold for Improved Patient-Reported Outcomes

14 citations , June 2022 in “British Journal of Dermatology”

A SALT score of ≤ 20 indicates meaningful improvement in alopecia areata treatment.

research Candida Antigen Immunotherapy Versus Steroid in the Treatment of Alopecia Areata

1 citations , January 2021 in “Dermatologic Therapy”

Candida antigen is an effective and promising treatment for alopecia areata.

research Identification of Novel Step-Up Regimen of Intralesional Triamcinolone Acetonide in Scalp Alopecia Areata Based on a Double-Blind Randomized Controlled Trial

3 citations , November 2020 in “Dermatologic Therapy”

Start with 2.5 mg/mL triamcinolone acetonide for scalp alopecia areata and increase if needed.

research Efficacy of Intradermal Minoxidil 5% Injections for Treatment of Patchy Non-Severe Alopecia Areata

4 citations , July 2020 in “Journal of Dermatological Treatment”

Minoxidil injections can speed up hair regrowth in non-severe patchy hair loss, but combining it with steroids doesn't improve results.

research Benefit and Risk Profile of Tofacitinib for the Treatment of Alopecia Areata: A Systematic Review and Meta-Analysis

54 citations , September 2019 in “Journal of the European Academy of Dermatology and Venereology”

Tofacitinib is somewhat effective for alopecia areata, but more research is needed on its safety and long-term effects.

research Weekly Azathioprine Pulse Versus Betamethasone Oral Mini-Pulse in the Treatment of Moderate-to-Severe Alopecia Areata

10 citations , July 2019 in “Indian Journal of Dermatology”

Weekly azathioprine pulse is a better alternative to corticosteroids for treating alopecia areata due to fewer side effects.

research Cyclosporine for Moderate-to-Severe Alopecia Areata: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial of Efficacy and Safety

44 citations , April 2019 in “Journal of the American Academy of Dermatology”

Cyclosporine showed some improvement in alopecia areata but results were not statistically significant.

research Minoxidil for Patchy Alopecia Areata: Systematic Review and Meta-Analysis

20 citations , March 2019 in “Journal of The European Academy of Dermatology and Venereology”

Minoxidil effectively and safely treats patchy hair loss, but more research needed.

research Hair Regrowth Outcomes of Contact Immunotherapy for Patients With Alopecia Areata

89 citations , August 2018 in “JAMA Dermatology”

Contact immunotherapy can improve hair regrowth in alopecia areata patients.

research A Review of Monochromatic Light Devices for the Treatment of Alopecia Areata

28 citations , December 2017 in “Lasers in Medical Science”

Monochromatic light devices, especially the 308-nm excimer laser, are promising for treating alopecia areata but more research is needed.

research Best Dilution of the Best Corticosteroid for Intralesional Injection in the Treatment of Localized Alopecia Areata in Adults

22 citations , May 2017 in “Journal of dermatological treatment”

BD 1/4 dilution is the best for treating localized alopecia areata in adults.

research Diphenylcyclopropenone in Patients with Alopecia Areata: A Critically Appraised Topic

19 citations , October 2015 in “British Journal of Dermatology”

Diphenylcyclopropenone's effectiveness and safety for alopecia areata are unclear.

research Bimatoprost Versus Mometasone Furoate in the Treatment of Scalp Alopecia Areata: A Pilot Study

36 citations , January 2015 in “Dermatology”

Bimatoprost was found to be safer and more effective than mometasone furoate for treating scalp hair loss.

research Oral Zinc Sulfate in the Treatment of Alopecia Areata: A Double-Blind, Cross-Over Study

20 citations , January 2014 in “Journal of Clinical & Experimental Dermatology Research”

Oral zinc sulphate effectively treats alopecia areata with few side effects.

research Excimer Laser: A Module of the Alopecia Areata Common Protocol

17 citations , December 2013 in “Journal of Investigative Dermatology Symposium Proceedings”

The excimer laser may help hair regrow in alopecia areata patients.

research Clobetasol Propionate, 0.05%, vs Hydrocortisone, 1%, for Alopecia Areata in Children

49 citations , November 2013 in “JAMA dermatology”

Clobetasol propionate, 0.05%, is more effective and safe for treating childhood alopecia areata than hydrocortisone, 1%.

Total Glucosides of Paeony Capsule Plus Compound Glycyrrhizin Tablets for the Treatment of Severe Alopecia Areata in Children: A Randomized Controlled Trial

research Total Glucosides of Paeony Capsule Plus Compound Glycyrrhizin Tablets for the Treatment of Severe Alopecia Areata in Children: A Randomized Controlled Trial

20 citations , January 2013 in “Evidence-based complementary and alternative medicine”

TGPC plus CGT is effective and safe for treating severe alopecia areata in children.

research A Randomized Controlled Trial Comparing Total Glucosides of Paeony Capsule and Compound Glycyrrhizin Tablet for Alopecia Areata

18 citations , August 2012 in “Chinese journal of integrative medicine/Chinese Journal of Integrative Medicine”

Both treatments for alopecia areata are equally effective and safe.

research A Study to Evaluate the Efficacy of Various Topical Treatment Modalities for Alopecia Areata

20 citations , January 2012 in “International journal of trichology”

Steroids are the best treatment for Alopecia Areata with few side effects.

research Comparison of Treatment with Clobetasol Propionate 0.05% and Topical Pimecrolimus 1% in Alopecia Areata

13 citations , July 2011 in “Journal of Dermatological Treatment”

Clobetasol and pimecrolimus are similarly effective for alopecia areata, but pimecrolimus has fewer side effects and is preferred for long-term use.

Randomized Comparison of Topical Betamethasone Valerate Foam, Intralesional Triamcinolone Acetonide, and Tacrolimus Ointment in Management of Localized Alopecia Areata

research Randomized Comparison of Topical Betamethasone Valerate Foam, Intralesional Triamcinolone Acetonide, and Tacrolimus Ointment in Management of Localized Alopecia Areata

48 citations , January 2011 in “International journal of trichology”

Intralesional triamcinolone acetonide is the most effective treatment for localized alopecia areata.

research Alefacept for Severe Alopecia Areata: A Multicenter, Double-Blind, Randomized, Placebo-Controlled Clinical Trial

43 citations , November 2009 in “Archives of dermatology”

Alefacept does not effectively treat severe alopecia areata.

research Efficacy And Safety Of A New Clobetasol Propionate 0.05% Foam In Alopecia Areata: A Randomized, Double-Blind Placebo-Controlled Trial

114 citations , October 2006 in “Journal of the European Academy of Dermatology and Venereology”

The new clobetasol propionate foam is effective and safe for treating alopecia areata.

research Comparison of Azelaic Acid and Anthralin for the Therapy of Patchy Alopecia Areata

27 citations , January 2005 in “American Journal of Clinical Dermatology”

Azelaic acid and anthralin are similarly effective for treating patchy hair loss.

Efficacy of Betamethasone Valerate Foam Formulation in Comparison with Betamethasone Dipropionate Lotion in the Treatment of Mild-to-Moderate Alopecia Areata: A Multicenter, Prospective, Randomized, Controlled, Investigator-Blinded Trial

research Efficacy of Betamethasone Valerate Foam Formulation in Comparison with Betamethasone Dipropionate Lotion in the Treatment of Mild-to-Moderate Alopecia Areata: A Multicenter, Prospective, Randomized, Controlled, Investigator-Blinded Trial

66 citations , July 2003 in “International Journal of Dermatology”

Betamethasone valerate foam is more effective and safe for treating mild-to-moderate alopecia areata than betamethasone dipropionate lotion.

research Dapsone Versus Topical Immunotherapy in Alopecia Areata

13 citations , August 1995 in “British Journal of Dermatology”

Topical immunotherapy is more effective than dapsone for treating severe alopecia areata.