Treatment of pediatric alopecia areata: A systematic review - 01/07/21

Doi : 10.1016/j.jaad.2021.04.077

Virginia R. Barton, MD ^a, Atrin Toussi, MD ^a, Smita Awasthi, MD ^a,^b, Maija Kiuru, MD, PhD ^a,^c,^⁎
^a Department of Dermatology, University of California Davis, Sacramento, California
^b Department of Pediatrics, University of California Davis, Sacramento, California
^c Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California

^∗Correspondence to: Maija Kiuru, MD, PhD, Department of Dermatology, University of California, Davis, School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA 95816.Department of DermatologyUniversity of California, DavisSchool of Medicine3301 C Street, Suite 1400SacramentoCA95816

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Abstract

Background

Alopecia areata (AA) is an autoimmune, nonscarring hair loss disorder with slightly greater prevalence in children than adults. Various treatment modalities exist; however, their evidence in pediatric AA patients is lacking.

Objective

To evaluate the evidence of current treatment modalities for pediatric AA.

Methods

We conducted a systematic review on the PubMed database in October 2019 for all published articles involving patients <18 years old. Articles discussing AA treatment in pediatric patients were included, as were articles discussing both pediatric and adult patients, if data on individual pediatric patients were available.

Results

Inclusion criteria were met by 122 total reports discussing 1032 patients. Reports consisted of 2 randomized controlled trials, 4 prospective comparative cohorts, 83 case series, 2 case-control studies, and 31 case reports. Included articles assessed the use of aloe, apremilast, anthralin, anti-interferon gamma antibodies, botulinum toxin, corticosteroids, contact immunotherapies, cryotherapy, hydroxychloroquine, hypnotherapy, imiquimod, Janus kinase inhibitors, laser and light therapy, methotrexate, minoxidil, phototherapy, psychotherapy, prostaglandin analogs, sulfasalazine, topical calcineurin inhibitors, topical nitrogen mustard, and ustekinumab.

Limitations

English-only articles with full texts were used. Manuscripts with adult and pediatric data were only incorporated if individual-level data for pediatric patients were provided. No meta-analysis was performed.

Conclusion

Topical corticosteroids are the preferred first-line treatment for pediatric AA, as they hold the highest level of evidence, followed by contact immunotherapy. More clinical trials and comparative studies are needed to further guide management of pediatric AA and to promote the potential use of pre-existing, low-cost, and novel therapies, including Janus kinase inhibitors.

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Key words : alopecia areata, contact immunotherapy, corticosteroids, JAK inhibitors, pediatric, quality of life

Abbreviations used : AA, AO, AT, AU, DPCP, LAD, LoE, PRISMA, RCT, SADBE

Plan

Laser and phototherapy

Discussion

Conclusions

	Drs Barton and Toussi contributed equally to this article.
	Funding sources: Dr Kiuru's involvement in this article is in part supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award number K23AR074530.
	IRB approval status: Not applicable.
	Reprints not available from the authors.