Prescribing patterns amongst UK dermatologists for the treatment of alopecia areata, female pattern hair loss, and frontal fibrosing alopecia

Abstract

Background

Therapeutic management of hair loss is frequently complicated by a lack of high-quality evidence and reliant on the use of unlicensed therapies. Treatment decision-making is predominantly based on expert opinion, local availability, personal experience, and cost, which make informed choices challenging for clinicians and patients in this area.

Objectives

The aims were to determine prescribing patterns amongst UK Dermatologists with a special interest in hair disorders, when treating mild-moderate alopecia areata (AA), severe AA (including alopecia totalis/alopecia universalis), female pattern hair loss (FPHL) and frontal fibrosing alopecia (FFA).

Methods

Consultant members of the British Hair and Nail society, a special interest group affiliated to the British Association of Dermatologists, were invited to participate from across the United Kingdom. Participants were questioned on their current prescribing patterns in both NHS and private practice, were asked to rank their first-to-fifth line treatments for each condition and highlight the treatment they perceive as most effective for each disorder.

Results

Twenty-six Consultant Dermatologists completed the questionnaire, from twenty-three institutions. For treatment of mild-moderate AA, topical corticosteroids were used first line amongst 65% (n = 17) of respondents, and 82% (n = 23) reported that intralesional corticosteroids were the most effective treatment. For severe AA, oral corticosteroids were used first line amongst 38% (n = 10) of respondents, and 25% (n = 8) reported that oral corticosteroids were the most effective treatment. For FPHL, topical minoxidil was used first line amongst 84% (n = 25) of respondents, and 42% (n = 10) reported that oral minoxidil was the most effective treatment. For FFA, topical corticosteroids were used first line amongst 62% (n = 16) of respondents, and 37% (n = 14) reported that hydroxychloroquine was the most effective treatment.

Conclusions

This study reports real-world prescribing practices amongst dermatologists treating common hair loss conditions. These results aim to support clinicians with decision making for managing hair loss conditions.