Epidemiology, Diagnosis and Management of Alopecia Areata: An Asia-Pacific Modified Delphi Expert Panel Recommendations

Abstract

Background: Alopecia areata (AA) affects all ages, genders, and ethnicities. AA severely impacts patients' quality of life. Treatments indicated for AA have only been approved since 2022/2023. While some Asia Pacific (APAC) countries/regions have national or regional guidelines, many lack AA-specific guidance or have not updated existing guidelines to incorporate recently approved treatments. Methods: To better inform treatment decisions, 18 dermatologists from Australia, China, India, Korea, Malaysia, Singapore, Taiwan, and Thailand completed a three-round Delphi-based consensus process involving survey completion, open discussion, and statement voting. A consensus for Likert-type and multiple-choice statements was defined as ≥ 70% agreement or disagreement. Results: Consensus was achieved on 140 statements. The panel recognizes that AA is clinically heterogeneous and imposes a considerable burden on patients and their families. Trichoscopy is deemed essential for diagnosing and monitoring AA, while skin biopsy is reserved for when the cause of hair loss is unclear. In terms of disease severity, moderate AA is defined as 21%–49% hair loss and severe AA as ≥ 50% hair loss. Regarding treatment, topical corticosteroids are recommended in children < 12 years. For patients aged ≥ 12 years, topical and intralesional corticosteroids could be used for mild-to-moderate AA, while Janus kinase inhibitors and systemic corticosteroids have a role in moderate-to-severe AA. Adjuvant minoxidil could also be used in chronic AA. Conclusions: This modified Delphi-based consensus provides a practical, region-focused framework to standardize the diagnosis and management of AA across diverse APAC healthcare settings in hope of improving patient outcomes.