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.

COI Statement

Declarations. Conflict of Interest: Dr. Arash Mostaghimi is an Editorial Board member of Dermatology and Therapy; Dr. Mostaghimi was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Dr. Mostaghimi has received consulting fees from AbbVie, ACOM Health, Bioniz, Boehringer Ingelheim, Concert, Digital Diagnostics, Eli Lilly, Equillium, Hims & Hers Health, and Pfizer; equity from ACOM Health, Figure 1, and Hims & Hers Health; licensing/royalties from Concert and Pfizer; and research funding from Aclaris, Concert, Eli Lilly, and Incyte. Samantha Gregoire, Basil McIntosh, Katherine Sanchez, and Ursula Biba have no conflicts of interest to disclose. Ethical Approval: This article is based on previously conducted research and did not involve performing research on any human participants or animals by any of the authors.

References:

Pratt CH, King LE, Messenger AG, Christiano AM, Sundberg JP. Alopecia areata. Nat Rev Dis Primer. 2017;3:17011.
Mostaghimi A, Napatalung L, Sikirica V, et al. Patient perspectives of the social, emotional and functional impact of alopecia areata: a systematic literature review. Dermatol Ther. 2021;11:867–83.
Gandhi K, Shy ME, Ray M, Fridman M, Vaghela S, Mostaghimi A. The association of alopecia areata-related emotional symptoms with work productivity and daily activity among patients with alopecia areata. Dermatol Ther. 2023;13:285–98.
Mesinkovska N, Craiglow B, Ball SG, et al. The invisible impact of a visible disease: psychosocial impact of alopecia areata. Dermatol Ther. 2023;13:1503–15.
Bewley A, Figueras-Nart I, Zhang J, et al. Patient-reported burden of severe alopecia areata: first results from the multinational alopecia areata unmet need survey. Clin Cosmet Investig Dermatol. 2024;17:751–61.

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10.1007/s13555-025-01421-2

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Local Corticosteroids for Alopecia Areata: A Narrative Review.

Abstract

IL steroids are safe and well tolerated; however, treatment is limited by pain during the procedure.

COI Statement

References:

Pratt CH, King LE, Messenger AG, Christiano AM, Sundberg JP. Alopecia areata. Nat Rev Dis Primer. 2017;3:17011.
Mostaghimi A, Napatalung L, Sikirica V, et al. Patient perspectives of the social, emotional and functional impact of alopecia areata: a systematic literature review. Dermatol Ther. 2021;11:867–83.
Gandhi K, Shy ME, Ray M, Fridman M, Vaghela S, Mostaghimi A. The association of alopecia areata-related emotional symptoms with work productivity and daily activity among patients with alopecia areata. Dermatol Ther. 2023;13:285–98.
Mesinkovska N, Craiglow B, Ball SG, et al. The invisible impact of a visible disease: psychosocial impact of alopecia areata. Dermatol Ther. 2023;13:1503–15.
Bewley A, Figueras-Nart I, Zhang J, et al. Patient-reported burden of severe alopecia areata: first results from the multinational alopecia areata unmet need survey. Clin Cosmet Investig Dermatol. 2024;17:751–61.