Taiwanese Dermatological Association consensus on the diagnosis and management of alopecia areata

Alopecia areata (AA), an autoimmune disorder that causes well defined patches of scalp hair loss, significantly impacts the quality of life and mental well being of patients and their families. However, the paucity of treatment guidelines and expert consensus for AA in Taiwan, compared to other dermatological conditions, leads to substantial heterogeneity in the therapeutic strategies employed by clinicians. To discuss strategies for managing AA, address knowledge gaps, and provide a reference for dermatologists and other specialists in Taiwan. The Taiwanese Dermatological Association held Expert Panel meetings between 2023 and 2024, during which experts reviewed existing evidence, shared clinical experiences, and reached consensus on recommendations for clinical classification, diagnosis, severity evaluation, and treatment options for AA. The statements were approved if they received agreement from more than 75% of the committee members. For mild to moderate AA, the consensus suggests that first line therapy may include topical corticosteroids or intralesional corticosteroid injections, with or without adjunctive topical 5% minoxidil. In severe AA cases, initial treatment options include oral or intravenous corticosteroids or oral Janus kinase inhibitors, potentially combined with topical or intralesional corticosteroids. AA not only impacts patients’ physical appearance but also their mental and social well-being. Therefore, in addition to hair recovery, it is crucial to address patients’ psychological adjustment. Given the diverse treatment options and the varying psychological impacts on AA patients, the most appropriate personalized treatment plan should be established through shared decision making between physicians and patients.