Utilizing age-appropriate treatments for alopecia areata

MIAMI BEACH, Fla. — Treatment options for alopecia areata are expanding, but practitioners with pediatric patients should be cognizant of what is appropriate for young individuals, according to a presenter here.

“This is the range of alopecia areata. It’s a very heterogeneous disease. It often has an onset in childhood, so we are going to be seeing a lot of these patients,” Brittany G. Craiglow, MD, associate professor of dermatology at Yale School of Medicine, said during a presentation at the Masters of Pediatric Dermatology meeting. “It’s often a really emotionally devastating disease. It’s very easy to say ‘oh, it’s just hair,’ but if it happens to you or your family member, it really is not. This can have a really profound impact on a child’s life.”

While research is advancing on different fronts for the disease, including exciting developments in Janus kinase inhibitors, choosing the right treatment for younger children includes weighing the risks and benefits of each treatment.

Very young children are most likely not going to benefit as much from prednisone or a JAK inhibitor, which each come with their own complications.

“For really little kids we don’t have a ton of options,” Craiglow said. “What’s so useful for families, especially when the kids are young, is to say, ‘hey look, the treatment landscape is really changing.’ If we need to be more aggressive down the line, we can. I really think this is a disease in 5 or 10 years that we’re going to look at as very treatable.”

Topical corticosteroids, often combined with topical minoxidil, is often a good option for young children with limited scalp involvement. Intralesional corticosteroids, however, are not appropriate for use in young children.

“Treatment should not be worse than the disease and we don’t want to be setting kids up for a fear of doctors for the rest of their life,” Craiglow said.

For some children, four to six doses of prednisone combined with other treatments can be beneficial; however, there could be a high rate of relapse.

Additionally, oral minoxidil has been a “game changer,” according to Craiglow, as it allows for hair growth without negative effects.