Local Corticosteroids for Alopecia Areata: A Narrative Review

Abstract

Alopecia areata (AA) is an autoimmune condition of non-scarring hair loss that affects 2% of the population worldwide. Topical and intralesional (IL) corticosteroids are the two most commonly used treatments for AA. These locally acting glucocorticoid derivatives are thought to treat AA by reducing the CD8+ T-cell-mediated immune attack on hair follicles. Topical corticosteroids are safe and well tolerated with moderate efficacy in mild AA, but recurrence is common after treatment cessation. They are recommended for children and adults with mild AA who cannot tolerate IL injections. IL steroids are more effective than topical steroids given their ability to penetrate the dermis, where the hair follicle resides. Success rates are higher than topical steroids in mild-to-moderate AA. IL steroids are safe and well tolerated; however, treatment is limited by pain during the procedure. Further research is needed on ideal treatment regimens, long-term safety, preferred candidates, and the role of combination therapy to further elucidate the role of local corticosteroids for AA in clinical practice. Alopecia areata is a common hair loss condition in which the immune system mistakenly attacks hair follicles, causing the hair to fall out. Topical steroids, which come in lotions, foams, ointments, and creams, as well as intralesional steroids, which are injected into the skin, are the two most commonly used treatments for alopecia areata. They are thought to treat alopecia areata by reducing the immune system attack on hair follicles. Topical steroids are moderately effective for patients with mild alopecia areata, but the disease may recur after treatment is stopped. Intralesional steroid injections are more effective than topical steroids because they are able to deliver the treatment deeper in the skin, where the hair follicle is located. Both topical and intralesional steroids are safe, with mild side effects that usually resolve once treatment is stopped. However, intralesional steroid injections can be painful, which often limits their use, especially in children or patients with complete scalp hair loss. More high-quality research studies are needed to better understand how topical and intralesional steroids should be used for safe and effective alopecia areata treatment.

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