Overview
Circumscribed alopecia areata (AA) of the scalp refers to a localized form of hair loss characterized by well-defined patches. It is a common autoimmune condition affecting hair follicles 1.Diagnosis
Diagnosis is primarily clinical, based on the characteristic appearance of well-demarcated, non-scarring patches of hair loss 1.
Dermoscopy can aid in identifying specific features such as exclamation mark hairs, yellow dots, and broken hairs 1.
Scalp biopsy is generally not required for diagnosis but may be considered in atypical cases or for differential diagnosis 1.Management
First-line treatment options include topical corticosteroids, intralesional corticosteroids, and topical minoxidil 1.
Systemic corticosteroids may be considered for more extensive or rapidly progressing disease 1.
Newer treatment modalities include JAK inhibitors and TEC family kinase selective inhibitors, with specific recommendations for their use 1.
Phototherapy (e.g., PUVA, excimer laser) can be an adjunctive treatment option 1.
Contact immunotherapy (e.g., DPCP, SADBE) is another treatment option, particularly for more severe cases 1.Key Recommendations
Topical corticosteroids and intralesional corticosteroids are recommended for the treatment of circumscribed alopecia areata 1. (Evidence: Strong)
Topical minoxidil can be used as an adjunctive treatment 1. (Evidence: Moderate)
JAK inhibitors and TEC family kinase selective inhibitors are recommended for the management of alopecia areata, considering recent approvals 1. (Evidence: Strong)References
1 Ohyama M, Ito T, Amoh Y, Inui S, Imanishi H, Ueki R et al.. Japanese Dermatological Association's Clinical Practice Guidelines for Alopecia Areata 2024: A Complete English Translated Version. The Journal of dermatology 2025. link