Document Type

Article

Publication Date

12-1-2024

Comments

This article is the author’s final published version in JAAD Reviews, Volume 2, 2024, Pages 57-66.

The published version is available at https://doi.org/10.1016/j.jdrv.2024.08.013. Copyright © 2024 The Author(s).

Abstract

Background: Available treatment options for pediatric alopecia areata are limited and may even exacerbate the physical and psychosocial burden. Objective: This article aimed to provide a treatment classification system and counseling recommendations. Recommendations: Topical corticosteroids are appropriate for initial treatment due to their ease of use and safety. Topical minoxidil and dithranol are often used as adjunctive treatments based on mixed data. Intralesional corticosteroids are effective for localized disease, but injections may be challenging in children. Contact immunotherapy, systemic corticosteroids, and immunosuppressive agents such as topical and oral Janus kinase (JAK) inhibitors, dupilumab, and low-dose methotrexate demonstrate varying effectiveness, adverse effects, and cost. Although ineffective in adults, topical JAK inhibitors may sometimes be effective in children. Conditions that impact the quality of life in pediatric patients with alopecia areata such as depression and social isolation should be addressed. Limitations: Some data originate from case reports and series, which may limit validity and generalizability. Conclusions: Shared decision-making and patient-centered communication are essential in managing pediatric alopecia areata. Treatment should be based on disease severity, individual patient goals, and adverse effect profiles. As topical and systemic JAK inhibitors, dupilumab, and related compounds advance the treatment of alopecia areata in children, clinicians should be alert to cost, potential side effects, and the enduring role of older topical therapies.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

Language

English

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