Clinical Dermatology
Comprehensive management of autoimmune hair loss — intralesional steroids, immunotherapy, JAK inhibitors, and PRP for alopecia areata and its variants.
Alopecia areata is an autoimmune condition where the immune system mistakenly attacks hair follicles, causing sudden, patchy hair loss. It can range from a single small patch to complete loss of all scalp hair (alopecia totalis) or all body hair (alopecia universalis).
Understanding alopecia areata:
Unlike male/female pattern hair loss (which is gradual and genetic), alopecia areata is:
- Sudden onset: Patches appear over days to weeks
- Autoimmune: Driven by T-lymphocytes attacking the hair follicle bulb
- Unpredictable: May resolve spontaneously, remain stable, or progress
- Potentially reversible: The follicle is not destroyed — hair can regrow if the immune attack is controlled
Types treated at Vernon:
Patchy alopecia areata: One or more coin-sized smooth bald patches. The most common form and most responsive to treatment.
Alopecia totalis: Complete loss of all scalp hair.
Alopecia universalis: Complete loss of all body hair including eyebrows and eyelashes.
Ophiasis pattern: Band-like hair loss along the temporal and occipital scalp margins. More resistant to treatment.
Treatment protocol at Vernon:
First-line — Intralesional corticosteroid injection:
Triamcinolone acetonide (2.5–10mg/ml) is injected directly into the bald patches every 4–6 weeks. This is the gold standard for limited patchy alopecia areata, with regrowth seen in 60–70% of patients within 4–8 weeks of starting treatment.
Second-line — Topical immunotherapy (DPCP/SADBE):
For extensive alopecia areata, we apply a contact sensitizer to the scalp that redirects the immune response away from hair follicles. This requires careful medical supervision and regular visits.
Emerging — JAK inhibitors:
Oral tofacitinib or baricitinib show remarkable efficacy in moderate to severe alopecia areata. Ritlecitinib (FDA-approved 2023) is specifically designed for alopecia areata. These represent a genuine breakthrough for patients with extensive disease.
Adjunctive — PRP therapy:
PRP growth factors support follicle recovery and can accelerate regrowth when combined with corticosteroid or immunotherapy.
Prognostic factors:
- Early onset (childhood) — more likely to have extensive disease
- Nail changes (pitting, ridging) — indicates more active autoimmune process
- Family history of autoimmune conditions — higher recurrence risk
- Ophiasis pattern — more resistant to treatment
- Single small patch in an adult — best prognosis
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