Hair disorders: Diagnosis and management of androgenetic alopecia and alopecia areata

Among the most common hair diseases, affecting both men and women, androgenetic alopecia is a chronic condition characterized by progressive hair thinning in genetically predisposed individuals, hair goes through the gradual conversion of terminal hair into indeterminate hair and, finally, to vellus hair.

The incidence and the severity of androgenetic alopecia tends to be highest in Caucasian males, followed by Asian and African Americans, whilst lowest in Native Americans and Eskimos. Almost all patients experience an onset prior to 40 years of age, although many patients (both male and female) show evidence of the disorder before the age of 30. Currently, there are only two medications with solid evidence of efficacy in the treatment of androgenetic alopecia, namely minoxidil and finasteride. Another treatment option is surgery, which has been successfully performed for the past four decades.

Another well-known hair disorder covered in EADV’s sessions is alopecia areata, is an autoimmune form of non-scarring hair loss that may affect any hair-bearing area. Based on the extent of hair loss, alopecia areata is classified as: patchy alopecia areata with partial scalp hair loss, alopecia areata totalis with complete scalp hair loss, and alopecia areata universalis with complete scalp and body hair loss.

The diagnosis of alopecia areata is commonly established based on clinical appearance. However, there are several hair and scalp disorders that share similar clinical features with alopecia areata, such as tinea capitis, trichotillomania or frontal fibrosing alopecia. Trichoscopy as a fast, non-invasive and easy-to-perform technique may help to identify subtle details and establish the correct diagnosis.

In spite of numerous advances made in recent years, the treatment of severe alopecia areata still represents a formidable challenge. Treatment options include topical therapies, such as topical immunotherapy, corticosteroids, tacrolimus, dithranol, minoxidil and, very recently, topical JAK inhibitors. In regards to systemic options, oral corticosteroids, methotrexate, cyclosporine, biologic agents, and JAK inhibitors are some of the more commonly used drugs. According to the data available so far, corticosteroids and JAK inhibitors are the two most effective treatment options (both orally and topically). Some of the newest therapies being evaluated include biologic agents like TNF blockers, IFN-Y inhibitors, anti CTLA-4 agents, IL-17 inhibitors and IL-4 inhibitors, among others. Specifically, Janus kinase inhibitors have shown to be highly promising as future therapy. However, their long-term safety is yet to be evaluated.

Session speakers

  • Ramon Grimalt – Terrassa, Spain
  • Anna Waskiel – Warsaw, Poland
  • Nawaf Al-Mutairi – Farwaniya, Kuwait
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