This handout is for alopecia areata (dermatology lens). Your care team identified this based on: abrupt well-circumscribed round/oval patch(es) of non-scarring scalp/beard hair loss with smooth skin + preserved follicular ostia (pratt et al, nat rev dis primers 2017 pmid 28300084).
Other reasons your team may use this plan: trichoscopy pivots — exclamation-mark hairs, yellow dots, black dots, broom/tapered hairs, short regrowing vellus at patch periphery (pratt et al pmid 28300084); extensive (≥50% scalp), alopecia totalis (whole scalp), alopecia universalis (all body hair), or ophiasis-pattern loss → systemic-ladder entry (european consensus, rudnicka et al, jeadv 2024 pmid 38169088); personal/family autoimmune (thyroid, vitiligo, t1dm) or atopic diathesis, or family history of aa — comorbidity-screen entry (pratt et al pmid 28300084).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| psychological_support_and_mental_health_screen | — | — | — | Rudnicka et al JEADV 2024 (PMID 38169088) + Craiglow et al (PMID 38904749) — AA has high depression/anxiety burden (children frequently bullied); screen mood, signpost psychological support; sustained regrowth improves HRQoL/anxiety/depression. |
| wigs_camouflage_and_eyelash_eyebrow_options | — | — | — | Pratt et al Nat Rev Dis Primers 2017 (PMID 28300084) — wigs/hairpieces/camouflage + eyebrow tattoo/eyelash prostheses are core management for the cosmetic/psychosocial impact, independent of pharmacotherapy response. |
| watchful_waiting_for_limited_recent_onset | — | — | — | Pratt et al (PMID 28300084) — limited recent-onset patchy AA has high spontaneous regrowth; active observation ± topical adjunct is a legitimate option, avoiding overtreatment. |
Plan: Alopecia areata — extent/SALT/age-stratified ladder + psychological support (European consensus 2024)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Chronic-disease maintenance: counsel the unpredictable relapsing course + realistic regrowth expectations (lower for long-standing AT/AU; high spontaneous regrowth for limited recent-onset), relapse-on-JAK-discontinuation, lifelong autoimmune (thyroid/vitiligo/T1DM) + atopic + mental-health surveillance, wig/camouflage + peer-support signposting, eyelash/eyebrow care, sun/ocular protection where brows/lashes lost, and step-up/step-down criteria. Dermatology continuity for any systemic agent; re-evaluate diagnosis (biopsy) if the course is atypical or scarring features emerge.
Guideline: European expert consensus statement on the systemic treatment of alopecia areata (Rudnicka et al, J Eur Acad Dermatol Venereol 2024; PMID 38169088, DOI 10.1111/jdv.19768 — SALT ≥20 / moderate–severe AAS systemic indication; baricitinib + ritlecitinib EMA/FDA-approved; off-label glucocorticoid/ciclosporin/MTX/azathioprine; oral minoxidil adjuvant; against chronic systemic steroids) anchored by pivotal RCTs: BRAVE-AA1/AA2 baricitinib (King et al, NEJM 2022; PMID 35334197), ALLEGRO 2b/3 ritlecitinib ≥12 y (King et al, Lancet 2023; PMID 37062298), THRIVE-AA1 deuruxolitinib (King et al, JAAD 2024; PMID 39053611); disease primer (Pratt et al, Nat Rev Dis Primers 2017; PMID 28300084); topical immunotherapy review (Singh & Lavanya, Int J Trichology 2010; PMID 21188022); intralesional-steroid RCT (Khan et al, JAMC 2022; PMID 36566395) + comparative (Ragaie et al, J Cosmet Laser Ther 2024; PMID 39139085); baricitinib QoL/anxiety-depression (Craiglow et al, Dermatol Ther 2024; PMID 38904749)