Table 2.
Current treatments used for AA in LA
| Type of treatment | Active component | Response rate or effectivity | Used for AA Severity | Adverse effects | Availability | Accessible through public healthcare |
|---|---|---|---|---|---|---|
| Topical therapy | Clobetasol |
Foam 0.05%: 25% had 50% response Cream under occlusion: 28.5% had at least a 50% response Cream 0.05%: 85% of children has at least a 50% response |
Monotherapy in mild cases or in combination with systemic therapy in moderate–severe cases | Folliculitis, local skin atrophy, striae, acneiform rash, telangiectasias, dyschromia, adrenal suppression |
ARG ✓ BRA ✓ COL ✓ MEX ✓ |
ARG ✖ BRA ✖ COL ✓ MEX ✓ |
| Minoxidil | 60% response with minoxidil 5% [58] | As adjuvant therapy | Hypertrichosis, local irritation [55] |
ARG ✓ BRA ✓ COL ✓ MEX ✓ |
ARG ✖ BRA ✓ COL ✓ MEX ✖ |
|
| Topical immunotherapy | Diphencyprone |
30–48% [8] global 28.3–87.9% AT and AU 72.2% for chronic extensive AA [59] |
Moderate–severe | Hyperpigmentation, hypopigmentation, folliculitis lymph node enlargement, severe dermatitis, blisters, and flu-like symptoms |
ARG ✓ BRA ✓ COL ✓ MEX ✖ |
ARG ✖ BRA ✖ COL ✖ MEX ✖ |
| Phototherapy | NB-UVB | 52.9% response week 12 (23 sessions) [60] | Mild–moderate | Pain, erythema, edema, blisters |
ARG ✓* BRA ✓* COL ✓* MEX ✓* |
ARG ✖ BRA ✓ COL ✓ MEX ✓ |
| Excimer laser/light treatment | Satisfactory regrowth in 50.2% patients [61] |
ARG ✓* BRA ✓* COL ✓* MEX ✓* |
ARG ✓* BRA ✖ COL ✓* MEX ✖ |
|||
| Intralesional corticosteroids | Triamcinolone | 60–75% | Mild–moderate | Pain, hemorrhage at puncture sites, headache, reversible local cutaneous atrophy, dyschromia, systemic absorption |
ARG ✓ BRA ✓ COL ✓ MEX ✓ |
ARG ✖ BRA ✖ COL ✓ MEX ✖ |
| Systemic corticosteroids | Prednisone | > 75% of regrowth with pulse therapy in 43% of total and 51% of children | Moderate–severe | Adrenal suppression, weight gain, Cushing’s syndrome, hypertension, osteoporosis, diabetes, immunosuppression, cataracts, acne |
ARG ✓ BRA ✓ COL ✓ MEX ✓ |
ARG ✖ BRA ✓ COL ✓ MEX ✓ |
| Dexamethasone | 51.8% achieved SALT50 after 9 months of oral mini pulse (< 5 mg/d, 2 days/week) [62] |
ARG ✓ BRA ✓ COL ✓ MEX ✓ |
ARG ✖ BRA ✓ COL ✓ MEX ✓ |
|||
| Conventional systemic immunomodulators | Methotrexate | Regrowth of > 50% in 63.2% of patients [63] | Moderate–severe | Hematologic toxicity, teratogenicity, immunosuppression, hepatotoxicity, interstitial pneumonitis |
ARG ✓ BRA ✓ COL ✓ MEX ✓ |
ARG ✖ BRA ✖ COL ✓ MEX ✓ |
| Cyclosporine |
< 6 months: 74% (53–88%) ≥ 6 months: 73% (47–89%) Recurrence after monotherapy: 55% (6–96%) CsA + systemic corticosteroids: 28% (6–72%) [64] |
Nephrotoxicity, immunosuppression, and arterial hypertension |
ARG ✓ BRA ✓ COL ✓ MEX ✓ |
ARG ✖ BRA ✖ COL ✓ MEX ✓ |
||
| Azathioprine | Regrowth of 52.3% after 6 months of treatment [65] | Gastrointestinal symptoms, elevated liver enzymes, pancreatitis, hematologic toxicity |
ARG ✓ BRA ✓ COL ✓ MEX ✓ |
ARG ✖ BRA ✖ COL ✓ MEX ✓ |
||
| JAK inhibitors | Ruxolitinib |
6 months: 95% had > 50% regrowth 12 weeks: 75% had > 50% regrowth |
Moderate–severe | Mild infections, mainly of the upper respiratory tract, dyslipidemia, leukopenia, increased liver enzymes, headache, gastrointestinal complaints, fatigue, acne, weight gain, thrombosis, acne, nausea, increase in serum creatin phosphokinase, herpes zoster** |
ARG ✓ BRA ✓ COL ✓ MEX ✓ |
ARG ✖ BRA ✖ COL ✖ MEX ✓ |
| Tofacitinib [66] |
Oral 10 mg/day: Reduction in SALT 70% (50–90%) Topical twice/day: Partial regrowth in 30% of patients |
ARG ✓ BRA ✓ COL ✓ MEX ✓ |
ARG ✖ BRA ✖ COL ✖ MEX ✖ |
|||
| Ritlecitinib [54] | 50% achieve SALT 30 score and 25% SALT 90 score after 24 months |
ARG ✖ BRA ✖ COL ✖ MEX ✖ |
ARG ✖ BRA ✖ COL ✖ MEX ✖ |
|||
| Baricitinib [57] |
Oral 2 mg/day: 33.3% Oral 4 mg/day: 54.4% Severity of alopecia score: < 20% at 36 weeks |
ARG ✓ BRA ✓ COL ✓ MEX ✓ |
ARG ✖ BRA ✖ COL ✖ MEX ✖ |
|||
| Biologics | Dupilumab [67] |
32.5% of patients achieved SALT 30 22.5% achieved SALT 50 15% achieved SALT 75 After 48 weeks of treatment |
Moderate–severe |
Conjunctivitis (in patients with atopic dermatitis) Injection-site reactions, headache, fatigue. Some reports of new onset or recurrent cases of AA after initiation for other indications [55] |
ARG ✓ BRA ✓ COL ✓ MEX ✓ |
ARG ✖ BRA ✖ COL ✖ MEX ✖ |
| Abatacept | 3–50% hair regrowth | Infections, headache, upper respiratory tract infection, nasopharyngitis, and nausea |
Checkmark ✓ = yes, ✖ = no
*Limited availability (only in major cities and select centers)