The Alopecia Areata Consensus of Experts (ACE) study: Results of an international expert opinion on treatments for alopecia areata.

Abstract

BACKGROUND:

A systematic review failed to identify any systemic therapy used in alopecia areata (AA) where use is supported by robust evidence from high-quality randomized controlled trials.

OBJECTIVE:

To produce an international consensus statement on the use and utility of various treatments for AA.

METHODS:

Fifty hair experts from 5 continents were invited to participate in a 3-round Delphi process. Agreement of 66% or greater was considered consensus.

RESULTS:

In the first round, consensus was achieved in 22 of 423 (5%) questions. After a face-to-face meeting in round 3, overall, consensus was achieved for only 130 (33%) treatment-specific questions. There was greater consensus for intralesional treatment of AA (19 [68%]) followed by topical treatment (25 [43%]). Consensus was achieved in 45 (36%) questions pertaining to systemic therapies in AA. The categories with the least consensus were phototherapy and nonprescription therapies.

LIMITATIONS:

The study included a comprehensive list of systemic treatments for AA but not all treatments used.

CONCLUSION:

Despite divergent opinions among experts, consensus was achieved on a number of pertinent questions. The concluding statement also highlights areas where expert consensus is lacking and where an international patient registry could enable further research.

• Authors: Nekma Meah, Dmitri Wall, Katherine York, Bevin Bhoyrul, Laita Bokhari, Daniel Asz Sigall, Wilma F Bergfeld, Regina C Betz, Ulrike Blume-Peytavi, Valerie Callender, Vijaya Chitreddy, Andrea Combalia, George Cotsarelis, Brittany Craiglow, Jeff Donovan, Samantha Eisman, Paul Farrant, Jack Green, Ramon Grimalt, Matthew Harries, Maria Hordinsky, Alan D Irvine, Satoshi Itami, Victoria Jolliffe, Brett King, Won-Soo Lee, Amy McMichael, Andrew Messenger, Paradi Mirmirani, Elise Olsen, Seth J Orlow, Bianca Maria Piraccini, Adriana Rakowska, Pascal Reygagne, Janet L Roberts, Lidia Rudnicka, Jerry Shapiro, Pooja Sharma, Antonella Tosti, Annika Vogt, Martin Wade, Leona Yip, Abraham Zlotogorski, Rodney Sinclair
• Journal: Journal of the American Academy of Dermatology (J Am Acad Dermatol) Vol. 83 Issue 1 Pg. 123-130 (Jul 2020) ISSN: 1097-6787 [Electronic] United States
• PMID: 32165196 (Publication Type: Consensus Development Conference, Journal Article)
• Copyright: Copyright © 2020 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Chemical References

• Adrenal Cortex Hormones
• Dermatologic Agents

Topics

• Administration, Oral
• Administration, Topical
• Adrenal Cortex Hormones (therapeutic use)
• Age Factors
• Alopecia Areata (drug therapy, therapy)
• Combined Modality Therapy
• Complementary Therapies
• Delphi Technique
• Dermatologic Agents (therapeutic use)
• Expert Testimony
• Humans
• Injections, Intralesional
• Phototherapy
• Severity of Illness Index
• Treatment Outcome