Treatment of alopecia areata: An Australian expert consensus statement
Treatment of alopecia areata: An Australian expert consensus statement
复制标题
DOI：
10.1111/ajd.12941
复制
发表时间：
2019-05-01
影响因子：
2
通讯作者：
Sinclair, Rodney
中科院分区：
文献类型：
--
作者：
Cranwel, William C.;Lai, Vivien W. Y.;Sinclair, Rodney
斑秃（AA）的严重程度从一个单一的小补丁，以完全失去头皮头发，体毛，睫毛和眉毛。虽然40%的所有受影响的个人只得到一个补丁，并将在6个月内实现自发的完全持久缓解，27%将开发额外的补丁，但仍然在12个月内实现完全持久缓解，33%将发展为慢性AA。如果不进行系统治疗，55%的慢性AA患者将出现持续性多灶复发和缓解性疾病，30%最终发展为全秃，15%发展为普秃。不可预测的过程和心理困扰归因于AA有助于与AA相关的疾病。目前，许多局部、病灶内和全身性药物用于治疗AA;然而，缺乏评估其使用、有效性和耐受性的数据。局部治疗，包括局部糖皮质激素，米诺地尔和免疫治疗，可用于有限的疾病的情况下。对于开始AA的全身治疗，没有普遍认可的适应症。全身治疗的可能适应症包括快速脱发、广泛疾病（>= 50%脱发）、慢性疾病、严重痛苦或这些因素的组合。目前可用的全身治疗包括糖皮质激素、甲氨蝶呤、环孢素、硫唑嘌呤、氨苯砜、吗替麦考酚酯、他克莫司和柳氮磺胺吡啶。最佳治疗算法尚未描述。本共识声明的目的是概述AA的治疗方案，包括全身治疗的适应症、全身治疗的适当选择、满意的结局指标以及何时停止成功或不成功的治疗。
Alopecia areata (AA) severity varies from a single small patch to complete loss of scalp hair, body hair, eyelashes and eyebrows. While 40% of all affected individuals only ever get one patch and will achieve a spontaneous complete durable remission within 6 months, 27% will develop additional patches but still achieve complete durable remission within 12 months and 33% will develop chronic AA. Without systemic treatment, 55% of individuals with chronic AA will have persistent multifocal relapsing and remitting disease, 30% will ultimately develop alopecia totalis and 15% will develop alopecia universalis. The unpredictable course and psychological distress attributable to AA contributes to the illness associated with AA. Numerous topical, intralesional and systemic agents are currently used to treat AA; however, there is a paucity of data evaluating their use, effectiveness and tolerability. Topical therapy, including topical glucocorticosteroids, minoxidil and immunotherapy, can be used in cases of limited disease. There are no universally agreed indications for initiating systemic treatment for AA. Possible indications for systemic treatment include rapid hair loss, extensive disease (>= 50% hair loss), chronic disease, severe distress or a combination of these factors. Currently available systemic treatments include glucocorticosteroids, methotrexate, ciclosporin, azathioprine, dapsone, mycophenolate mofetil, tacrolimus and sulfasalazine. The optimal treatment algorithm has not yet been described. The purpose of this consensus statement is to outline a treatment algorithm for AA, including the indications for systemic treatment, appropriate choice of systemic treatment, satisfactory outcome measures and when to discontinue successful or unsuccessful treatment.