Treatment of Alopecia Areata

  • C. Perret
  • R. Happle


The patchy form of alopecia areata has a high rate of spontaneous remission. In severe forms, the chance of a spontaneous regrowth is much lower but still present. This fact must be taken into account when different therapeutic modalities are evaluated. For topical therapeutics, efficacy must be established by treating only parts of the scalp, the nontreated areas serving as a control. Systemic drugs must be evaluated in placebo-controlled studies. Although alopecia areata is a disease that may cause major psychosocial problems, it is at any rate not life threatening. For this reason, the obtained results must be weighed against possible undesired effects. Maintenance treatment should be suitable for a long period of time, and possible long-term side effects must be taken into consideration.


Hair Growth Alopecia Areata Acta Derm Fluocinolone Acetonide Hair Regrowth 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Abell E, Munro DD (1973) Intralesional treatment of alopecia areata with triamcinolone aceto-nide by jet injector. Br J Dermatol 88:55–59PubMedCrossRefGoogle Scholar
  2. Amer MA, El Garf A (1983) Photochemotherapy and alopecia areata. Int J Dermatol 22:245–246PubMedCrossRefGoogle Scholar
  3. Baran LR (1964) Le risque d’amaurose au cours du traitement local des alopécies par cortico-thérapie injectable. Bull Soc Fr Dermatol Syphiligr 71:25–28Google Scholar
  4. Berger RA (1961) Alopecia areata of the eyebrows — corticosteroids. Arch Dermatol 83:151–155CrossRefGoogle Scholar
  5. Biren CA, Barr RJ (1986) Dermatologie application of cyclosporine. Arch Dermatol 122:1028–1032CrossRefGoogle Scholar
  6. Bröcker EB, Echternacht-Happle K, Hamm H, Happle R (1987) Abnormal expression of class I and class II major histocompatibility antigens in alopecia areata: modulation by topical immunotherapy. J Invest Dermatol 88:564–568PubMedCrossRefGoogle Scholar
  7. Burton JL, Shuster S (1975) Large doses of glucocorticoid in the treatment of alopecia areata. Acta Derm Venereol (Stockh) 55:493–196Google Scholar
  8. Caranzan FR, Bene MC, Fauré GC (1987) Peripheral blood T-lymphocyte subsets in the follow-up of psoriasis patients under PUVA therapy. Photodermatology 4:135–40PubMedGoogle Scholar
  9. Case PC, Mitchell AJ, Swanson NA, Vanderveen EE, Ellis CN, Headington JT (1984) Topical therapy of alopecia areata with squaric acid dibutyl ester. J Am Acad Dermatol 10:447–451PubMedCrossRefGoogle Scholar
  10. Claudy AL, Gagnaire D (1983) PUVA treatment of alopecia areata. Arch Dermatol 119:975–978PubMedCrossRefGoogle Scholar
  11. Dargie HJ, Dollery CT, Daniel J (1977) Minoxidil in resistant hypertension. Lancet ii: 515–518CrossRefGoogle Scholar
  12. Darvill FT (1963) Steroid therapy in alopecia universalis. A case report and review of the literature. Arch Dermatol 87:706–709PubMedCrossRefGoogle Scholar
  13. De Prost Y, Paquez F, Baspeyraz M, Touraine R (1984) Traitement des pelades sévères par applications locales de minoxidil. Ann Dermatol Venereol 111:613–614PubMedGoogle Scholar
  14. De Prost Y, Teillac D, Paquez F, Carrugi L, Bachelez H, Touraine R (1986) Placebo-controlled trial of topical cyclosporin in severe alopecia areata. Lancet 11:803–804CrossRefGoogle Scholar
  15. Devine BL, Fife R, Trust PM (1977) Minoxidil for severe hypertension after failure of other hypotensive drugs. Br Med J 2:667–669PubMedCrossRefGoogle Scholar
  16. Dillaha CJ, Rothman S (1952) Treatment of alopecia areata totalis and universalis with cortisone acetate. J Invest Dermatol 18:5–6PubMedCrossRefGoogle Scholar
  17. Fiedler-Weiss VC (1987) Topical minoxidil solution (1% and 5%) in the treatment of alopecia areata. J Am Acad Dermatol 16:745–748PubMedCrossRefGoogle Scholar
  18. Fiedler-Weiss VC, Rumsfield J, Buys CM, West DP, Wendrow A (1987) Evaluation of oral minoxidil in the treatment of alopecia areata. Arch Dermatol 123:1488–490PubMedCrossRefGoogle Scholar
  19. Frentz G (1977) Topical treatment of extended alopecia. Dermatologica 155:147–154PubMedCrossRefGoogle Scholar
  20. Frentz G (1985) Topical minoxidil for extended areate alopecia. Acta Derm Venereol (Stockh) 65:172–175Google Scholar
  21. Friedmann PS (1981) Disappearance of epidermal Langerhans cells during PUVA therapy. Br J Dermatol 105:219–221PubMedCrossRefGoogle Scholar
  22. Galbraith GMP, Thiers BH, Fudenberg HH (1984) An open-label trial of immunomodulation therapy with inosiplex (Isoprinosine) in patients with alopecia totalis and cell-mediated immunodeficiency. J Am Acad Dermatol 11:224–230Google Scholar
  23. Galbraith GMP, Thiers BH, Jensen J, Hoehler F (1987) A randomized double-blind study of inosiplex (Isoprinosine) therapy in patients with alopecia totalis. J Am Acad Dermatol 16:977–983Google Scholar
  24. Gebhart W, Schmidt JB, Schemper M, Spona J, Kopsa H, Zazgornik J (1986) Cyclosporin-Ainduced hair growth in human renal allograft recipients and alopecia areata. Arch Dermatol Res 278:238–240PubMedCrossRefGoogle Scholar
  25. Gombiner A, Malkinson FD (1961) Triamcinolone suspension in alopecia areata. Arch Dermatol 83:158–60CrossRefGoogle Scholar
  26. Gupta AK, Ellis CM, Tellner DC, Goldfarb MT, Voorhees J J (1988) Treatment of severe alopecia areata with oral cyclosporin. J Invest Dermatol 90:565Google Scholar
  27. Hamm H, Klemmer S, Kreuzer I, Steijlen PM, Happle R, Bröcker EB (1988) HLA-DR and HLA-DQ antigen expression of anagen and telogen hair bulbs in long-standing alopecia areata. Arch Dermatol Res 280:179–81PubMedCrossRefGoogle Scholar
  28. Happle R (1979) DNCB-Therapie der Alopecia areata. Z Hautkr 54:426–429PubMedGoogle Scholar
  29. Happle R (1980) Antigenic competition as a therapeutic concept for alopecia areata. Arch Dermatol Res 267:109–14PubMedCrossRefGoogle Scholar
  30. Happle R (1985a) The potential hazards of dinitrochlorobenzene. Arch Dermatol 121:330–332PubMedCrossRefGoogle Scholar
  31. Happle R (1985b) Immunologische Behandlung der Alopecia areata. Hautarzt 36 (Suppl VII): 108–11Google Scholar
  32. Happle R (1986) Alopecia areata und Alopecia totalis: Pathogenese und topische Immuntherapie mit Diphencyprone. Therapiewoche 36:2706–2716Google Scholar
  33. Happle R, Echternacht K (1977) Induction of hair growth in alopecia areata with DNCB. Lancet 11:1002–003CrossRefGoogle Scholar
  34. Happle R, Cebulla K, Echternacht-Happle K (1978) Dinitrochlorobenzene therapy for alopecia areata. Arch Dermatol 114:1629–631PubMedCrossRefGoogle Scholar
  35. Happle R, Kalveram KJ, Büchner U, Echternacht-Happle K, Göggelmann W, Summer KH (1980) Contact allergy as a therapeutic tool for alopecia areata: application of squaric acid dibutylester. Dermatologica 161:289–297PubMedCrossRefGoogle Scholar
  36. Happle R, Hausen BM, Wiesner-Menzel L (1983) Diphencyprone in the treatment of alopecia areata. Acta Derm Venereol (Stockh) 63:49–52Google Scholar
  37. Happle R, Klein HM, Macher E (1986) Topical immunotherapy changes the composition of the peribulbar infiltrate in alopecia areata. Arch Dermatol Res 278:214–218PubMedCrossRefGoogle Scholar
  38. Kahan BD (1982) Cyclosporin A: a selective anti-T cell agent. Clin Haematol 11:743–761PubMedGoogle Scholar
  39. Kern F, Hoffmann WH, Hambrick GW, Blizzard RM (1973) Alopecia areata. Immunologic studies and treatment with prednisone. Arch Dermatol 107:407–412Google Scholar
  40. Khoury EL, Price VH, Wong EL, Greenspan JS (1986) HLA-DR expression by hair follicle epithelial cells in alopecia areata: evidence that it is secondary to the lymphoid infiltration. J Invest Dermatol 86:484Google Scholar
  41. Kietzmann H, Hardung H, Christophers E (1985) Therapie der Alopecia areata mit Diphenyl-cyclopropenon. Hautarzt 36:331–335PubMedGoogle Scholar
  42. Kikuchi I, Horikawa S (1975) Perilymphatic atrophy of the skin. Arch Dermatol 111:795–796PubMedCrossRefGoogle Scholar
  43. Kohchiyama A, Hatamochi A, Ueki H (1985) Increased number of OKT6-positive dendritic cells in the hair follicles of patients with alopecia areata. Dermatologica 171:327–331PubMedCrossRefGoogle Scholar
  44. Lassus A, Kuanto U, Johansson E, Juvakoski T (1980) PUVA treatment for alopecia areata. Dermatologica 161:298–304PubMedCrossRefGoogle Scholar
  45. Leyden JJ, Kligman AM (1972) Treatment of alopecia areata with steroid solution. Arch Dermatol 106:924PubMedCrossRefGoogle Scholar
  46. Lowy M, Ledoux-Corbusier M, Achten G, Wybran J (1985) Clinical and immunologic response to Isoprinosine in alopecia areata and alopecia universalis: association with autoantibodies. J Am Acad Dermatol 12:78–84PubMedCrossRefGoogle Scholar
  47. MacDonald-Hull S, Norris JF (1988) Diphencyprone in the treatment of long-standing alopecia areata. Br J Dermatol 119:267–274CrossRefGoogle Scholar
  48. Maitland JM, Aldridge RD, Main RA, White MJ, Ormerod AD (1984) Topical minoxidil in the treatment of alopecia areata. Br Med J 288:794–795CrossRefGoogle Scholar
  49. Martin ES (1984) Treatment of alopecia areata profiting from “natural” allergy to nickel. Arch Dermatol 120:1138–139CrossRefGoogle Scholar
  50. Messenger AG, Bleehen SS (1985) Expression of HLA-DR by anagen hair follicles in alopecia areata. J Invest Dermatol 85:569–572PubMedCrossRefGoogle Scholar
  51. Michalowski R, Kuczynska L (1978) Long-term intramuscular triamcinolon-acetonide therapy in alopecia areata totalis and universalis. Arch Derm Res 261:73–76PubMedCrossRefGoogle Scholar
  52. Monk B, Williams HC (1988) Topical diphencyprone therapy in alopecia totalis. Br J Dermatol 119 (Suppl 33):16–17CrossRefGoogle Scholar
  53. Mork NJ, Gaudernack G, Braathen LR (1987) Effect of UVA and PUVA on allo-activating and antigen-presenting capacity of human epidermal Langerhans cells. Photodermatology 4:66–72PubMedGoogle Scholar
  54. Nakano Y (1977) Antigenic competition in the induction of contact sensitivity in mice. Immunology 33:167–78PubMedGoogle Scholar
  55. Ochsendorf FR, Mitron G, Milbradt R (1988) Treatment of alopecia areata with diphenylcyclopropenone. Z Hautkr 63:94–00PubMedGoogle Scholar
  56. Orecchia G, Douville H (1988) A 3-year treatment of alopecia areata with squaric acid dibuty-lester. Ann 1st Derm Clin Sper 42:179–85Google Scholar
  57. Orentreich N, Sturm HM, Weidman AI, Pelzig A (1960) Local injection of steroids and hair re-growth in alopecias. Arch Dermatol 82:894–902PubMedCrossRefGoogle Scholar
  58. Pascher F, Kurtin S, Andrade R (1970) Assay of 0.2% fluocinolone acetonide cream for alopecia areata and totalis. Dermatologica 141:193–202PubMedCrossRefGoogle Scholar
  59. Peereboom-Wynia JDR, van Joost T, Stolz E, Prins MEF (1986) Markers of immunologic injury in progressive alopecia areata. J Cutan Pathol 13:363–369PubMedCrossRefGoogle Scholar
  60. Perret C, Bröcker EB, Wiesner-Menzel L, Happle R (1982) In situ demonstration of T cells in alopecia areata. Arch Dermatol Res 273:155–58PubMedCrossRefGoogle Scholar
  61. Perret C, Wiesner-Menzel L, Happle R (1984) Immunohistochemical analysis of T-cell subsets in the peribulbar and intrabulbar infiltrates of alopecia areata. Acta Derm Venereol (Stockh) 64:26–30Google Scholar
  62. Perret CM, Steijlen PM, Happle R (1990, in press) Alopecia areata — pathogenesis and topical immunotherapy. Int J Dermatol (in press)Google Scholar
  63. Porter D, Burton JL (1971) A comparison of intra-lesional triamcinolone hexacetonide and triamcinolone acetonide in alopecia areata. Br J Dermatol 85:272–273PubMedCrossRefGoogle Scholar
  64. Price VH (1987a) Double-blind, placebo-controlled evaluation of topical minoxidil in extensive alopecia areata. J Am Acad Dermatol 16:730–736PubMedCrossRefGoogle Scholar
  65. Price VH (1987b) Topical minoxidil (3%) in extensive alopecia areata, including long-term efficacy. J Am Acad Dermatol 16:737–744PubMedCrossRefGoogle Scholar
  66. Rhodes EL, Dolman W, Kennedy C, Taylor RR (1981) Alopecia areata regrowth induced by primula obconica. Br J Dermatol 104:339–340PubMedCrossRefGoogle Scholar
  67. Rollier R, Warcewski Z (1974) Le traitement de la pelade par la Meladinine. Bull Soc Fr Dermatol Syphiligr 81:97Google Scholar
  68. Rony JR, Cohen DM (1955) The effect of cortisone in alopecia areata. J Invest Dermatol 25:285–287PubMedCrossRefGoogle Scholar
  69. Rosenberg E, Drake L (1976) Discussion of Dunaway DA. Alopecia areata. Arch Dermatol 112:256Google Scholar
  70. Selmanowitz VJ, Orentreich N (1974) Cutaneous corticosteroid injection and amaurosis. Arch Dermatol 110:729–734PubMedCrossRefGoogle Scholar
  71. Shelley WB, Harun JS, Lehman JM (1959) Long-term triamcinolone therapy of alopecia universalis. Arch Dermatol 80:91/433–93/435Google Scholar
  72. Todes-Taylor N, Turner R, Wood GS, Stratte PT, Morhenn VB (1984) T cell subpopulations in alopecia areata. J Am Acad Dermatol 11:216–223PubMedCrossRefGoogle Scholar
  73. Unger WP, Schemmer RJ (1978) Corticosteroids in the treatment of alopecia totalis. Arch Dermatol 114:1486–490PubMedCrossRefGoogle Scholar
  74. Valsecchi R, Cainelli T, Foiadelli L, Rossi A (1986) Topical immunotherapy of alopecia areata. A follow-up study. Acta Derm Venereol 66:269–272Google Scholar
  75. Vestey JP, Savin JA (1986) A trial of 1% minoxidil used topically for severe alopecia areata. Acta Derm Venereol (Stockh) 66:179–80Google Scholar
  76. von Bahr G (1963) Multiple embolisms in the fundus of an eye after an injection in the scalp. Acta Opthalmol 41:85–91CrossRefGoogle Scholar
  77. Weiss VC, West DP, Mueller CE (1981) Topical minoxidil in alopecia areata. J Am Acad Dermatol 5:224–226PubMedCrossRefGoogle Scholar
  78. Weiss VC, West DP, Fu TS Robinson LA, Cook B, Cohen RL, Chambers DA (1984) Alopecia areata treated with topical minoxidil. Arch Dermatol 120:457–463PubMedCrossRefGoogle Scholar
  79. Weissmann I, Hofmann C, Wagner G, Plewig G, Braun-Falco O (1978) PUVA-therapy for alopecia areata. An investigative study. Arch Dermatol Res 262:333–336Google Scholar
  80. White SJ, Friedmann PS (1985) Topical minoxidil lacks efficacy in alopecia areata. Arch Dermatol 121:591PubMedCrossRefGoogle Scholar
  81. Wiesner-Menzel L, Happle R (1984) Intrabulbar and peribulbar accumulation of dentritic OKT 6-positive cells in alopecia areata. Arch Dermatol Res 276:333–334PubMedCrossRefGoogle Scholar
  82. Winter RJ, Kern F, Blizzard RM (1976) Prednisone therapy for alopecia areata. A follow-up report. Arch Dermatol 112:1549–552PubMedCrossRefGoogle Scholar
  83. Yuan-Pei Shi (1986) Topical minoxidil in the treatment of alopecia areata and male-pattern alopecia. Arch Dermatol 122:506Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1990

Authors and Affiliations

  • C. Perret
  • R. Happle

There are no affiliations available

Personalised recommendations