What are the recommended first-line treatments for adults with alopecia areata?

Recommended first-line treatments for adults with alopecia areata include:

• A trial of potent topical corticosteroids such as betamethasone valerate 0.1%, fluocinolone acetonide 0.025%, hydrocortisone butyrate 0.1%, or very potent corticosteroids like clobetasol propionate 0.05% applied for 3 months. These can be prescribed as lotion, foam, or scalp application depending on patient preference. Note that potent corticosteroids should not be used on facial areas such as eyebrows or beard due to risk of adverse effects ¹.
• Intralesional corticosteroid injections (e.g., triamcinolone acetonide or hydrocortisone acetate) are considered a first-line treatment for limited patchy hair loss in adults, typically administered by dermatology specialists ¹.
• Watchful waiting may be appropriate if hair loss is limited, stable, not conspicuous, and not causing distress, especially if there is evidence of hair regrowth ¹.

Referral to dermatology is advised if there is diagnostic uncertainty, extensive or refractory disease, or if the patient wishes to consider other medical treatments beyond primary care options ¹.