Alopecia Areata

Question 1

What are the rates of recovery without treatment?

Answer 1

• Hair will regrow in 50% of patients by 1 year.
• Hair will regrow in 80-90% of patients eventually.

Question 2

What are the primary care treatment options?

Answer 2

• Reassurance
• Potent topical steroids (Betamethasone valerate or hydrocortisone butyrate)
  
  • non-pregnant adults only.
  • Not for the face.
  • High failure rate.
  • Will grow back thinner and depigmented initially.

Question 3

When should you refer to secondary care?

Answer 3

More than 50% hair loss.

Question 4

What are some options for treatment but are generally considered secondary care treatments?

Answer 4

• Dithranol
• Minoxidil
• Referral for wigs

Question 5

How does NICe recommend women with androgenic alopecia be managed?

Answer 5

• Styling
• Colouring
• Hair products
• Topical minoxidil may be helpful in 25% of women.

Question 6

How long does it take for regrowth to occur with minoxidil?

Answer 6

4 months and it should be continued long term if helping.

Question 7

Is minoxidil available on the NHS?

Answer 7

No.

Question 8

How do you get your patient to use minoxidil then if it is not available on the NHS?

Answer 8

Either private prescription or buy OTC.

It is a 2% solution.

Question 9

Aa a GP, can you prescribe anti-androgenic drugs for androgenic alopecia in female patients?

Answer 9

No.

(These include finasteride, spironolactone or cypoterone acetate.)

NOTE: A private prescription for finasteride can be offered to male patients as an alternative to minoxidil…but not for women.

Question 10

Alopecia is divided into scarring and non-scarring alopecia. What are the causes of non-scarring alopecia?

Answer 10

• Male-pattern baldness
• Medications: cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, colchicine
• Nutritional: iron and zinc deficiency
• Autoimmune: alopecia areata
• Telogen effluvium (hair loss following stressful period e.g. surgery)
• Trichotillomania

Question 11

Alopecia is divided into scarring and non-scarring alopecia. What are the causes of scarring alopecia?

Answer 11

• Trauma, burns
• Radiotherapy
• Lichen planus
• Discoid lupus
• Tinea capitis (if untreated)

Question 12

What medications can cause non-scarring alopecia?

Answer 12

• Cytotoxic drugs
• Carbimazole
• Heparin
• Oral contraceptive pill
• Colchicine