斑秃(AA)的严重程度从单个小片到头皮毛发完全丧失,体毛,睫毛和眉毛.虽然所有受影响的个体中有40%只能得到一个补丁,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,但仍在12个月内实现完全持久的缓解,33%将发展为慢性AA。如果没有全身治疗,55%的慢性AA患者将患有持续性多灶性复发和缓解疾病,30%将最终发展为全部脱发,15%将发展为普遍脱发。AA引起的不可预测的病程和心理困扰会导致与AA相关的疾病。众多的主题,病灶内和全身药物目前用于治疗AA;然而,缺乏评估其使用的数据,有效性和耐受性。局部治疗,包括外用糖皮质激素,米诺地尔和免疫疗法,可以在有限的疾病的情况下使用。没有普遍认可的开始全身治疗AA的适应症。全身治疗的可能适应症包括快速脱发,广泛性疾病(≥50%脱发),慢性疾病,严重的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,霉酚酸酯,他克莫司和柳氮磺吡啶.尚未描述最佳治疗算法。此共识声明的目的是概述AA的治疗算法,包括全身治疗的适应症,适当选择全身治疗,令人满意的结果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.