Practical Evidence About Real Life Situations
PEARLS are succinct summaries of Cochrane Systematic Reviews for primary care practitioners. They
are funded by the New Zealand Guidelines Group.
PEARLS provide guidance on whether a treatment is effective or ineffective. PEARLS are prepared as
an educational resource and do not replace clinician judgement in the management of individual cases.
View PEARLS online at:
No evidence of effective treatments for alopecia
How effective are treatments for alopecia?
There is no good trial evidence that any treatments provide
long-term benefit to patients with alopecia areata, alopecia
totalis and alopecia universalis. There are no randomised
controlled trials on the use of diphencyprone,
dinitrochlorobenzene, intralesional corticosteroids or
dithranol, although they are commonly used for the
treatment of alopecia areata. Similarly, although topical
steroids and minoxidil are widely prescribed and appear to
be safe, there is no convincing evidence that they are
beneficial in the long-term.
Most trials have been reported poorly and are so small that
any important clinical benefits are inconclusive. Some of
the skin treatments can have unpleasant side effects, such
as itching or hair growth in areas of the body away from
where the cream was applied. Oral steroids may cause
serious side effects. Also, there is no guarantee that any
hair regrown during treatment will persist once treatment is
finished. None of the studies asked participants to report
their opinion of hair growth or whether their quality of life
had improved with treatment.
Alopecia areata is a condition that causes patchy hair loss.
The size and number of patches and progress of the
disease can vary between people. It can affect the entire
scalp (alopecia totalis) or cause loss of all body hair
(alopecia universalis). It is a relatively common condition,
affecting 0.15% of the populati