Clinical question
How effective and safe are treatments for alopecia areata in children and adults?
Bottom line
Among the interventions evaluated, only baricitinib compared with placebo resulted in a beneficial impact on short and long-term hair regrowth with high certainty of evidence. However, there were inconclusive results for the risk of serious adverse effects with baricitinib compared with placebo, with low certainty of evidence. No additional studies assessed long-term hair regrowth.
Minoxidil compared with placebo may increase short-term hair regrowth, although the certainty of the evidence was very low. The remaining interventions showed little to no impact on short-term hair regrowth with low or very-low-certainty evidence. Evidence for health-related quality of life was scant.
Caveat
In general, the studies had small sample sizes and were judged to be at high risk of bias. Except for baricitinib, there was insufficient evidence to determine the effectiveness of many treatments. The reported small incidence of serious adverse events in the baricitinib arm should be balanced with the expected benefits.
In future, studies should be designed with enough participants. This would allow valid and accurate estimates of the efficacy of therapies that have previously shown promising results.
Context
Alopecia areata is a common condition characterised by localised or diffuse hair loss on the scalp or around the body. Almost half of patients have new hair growth without treatment, but a considerable number still require specific treatment. For patients who need medication, there are multiple treatments, including topical therapies, oral treatments, localised corticosteroid injections, cryotherapy and laser treatment.
Cochrane Systematic Review
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