Treatment of Pediatric Alopecia Areata: A Systematic Review

Background: Alopecia areata (AA) is an autoimmune, non-scarring hair loss disorder with slightly greater prevalence in children than adults. Various treatment modalities exist; however, their evidence in pediatric AA patients is lacking.
Methods: We conducted a systematic review on the PubMed database in October 2019 for all published articles involving patients <18 years old. Articles discussing AA treatment in pediatric patients, and both pediatric and adult patients, were included if individual data on pediatric patients was available.
Results: 122 total reports discussing 1,032 patients met inclusion criteria. Reports consisted of two randomized controlled trials, four prospective comparative cohorts, 83 case series, two case-control studies, and 31 case reports. Included articles assessed the use of aloe, apremilast, anthralin, anti-IFN gamma antibodies, botulinum toxin, corticosteroids, contact immunotherapies, cryotherapy, hydroxychloroquine, hypnotherapy, imiquimod, JAK inhibitors, laser and light therapy, methotrexate, minoxidil, phototherapy, psychotherapy, prostaglandin analogs, sulfasalazine, topical calcineurin inhibitors, topical nitrogen mustard, and ustekinumab.
Conclusion: Topical corticosteroids are the preferred first-line treatment for pediatric AA, as they hold the highest level of evidence, followed by contact immunotherapy. More clinical trials and comparative studies are needed to further guide management of pediatric AA, and to promote potential use of pre-existing, low-cost, and novel therapies, including JAK inhibitors.