Attitudes of dermatologists in the southeastern United States regarding treatment of alopecia areata: a cross-sectional survey study

Dermatologists were sent anonymous questionnaires regarding their treatment practices by mail. Respondents' frequencies of treatment in children compared to adults and in patchy hair loss compared to widespread hair loss were compared with Wilcoxon signed-ranks tests and Friedman tests. As a secondary source, the National Alopecia Areata Registry (NAAR) database was analyzed for patients' treatment histories.Survey results suggested that dermatologists recommend treatment less frequently for children than adults and for more advanced hair loss. NAAR data confirmed that offering no treatment for AA is relatively common.Dermatologists' treatment of AA is inconsistent. A stronger evidence base will provide more consistent treatment options.Alopecia areata (AA) is relatively common, accounting for 2% of new dermatology outpatient visits in the United States and the United Kingdom [1], but little is yet known about optimal treatment of the disease. Many AA treatments, including topical, intralesional and oral corticosteroids, minoxidil, contact sensitizers, anthralin, and PUVA [2], have not been critically evaluated. Though treatments such as corticosteroids have been commonly used with reported success for years, only rarely have AA treatments been thoroughly evaluated in randomized controlled trials; these trials have often been limited in scope and have demonstrated little benefit [3]. Notably, intralesional corticosteroid treatment, one of the most commonly used AA treatments [4], has never been evaluated in a randomized controlled trial [3].In the absence of a strong evidence base, treatment guidelines that stratify patients by age and disease extent have been proposed [5-7]. These guidelines recommend intralesional steroids as first line therapy for patch hair loss in adults. They generally do not recommend painful or more aggressive treatments for children under 10. Because alopecia totalis (AT) and universalis (AU) are more difficult to treat than patch hair loss