chronic

Alopecia areata (patchy hair loss)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

British Association of Dermatologists living guideline for managing people with alopecia areata 2024 (Br J Dermatol 2025;192:190-205) for the indication, with the product and its application from Dermovate (clobetasol propionate 0.05%) Cream SmPC section 4.2 (eMC product 939): "Apply thinly and gently rub in using only enough to cover the entire affected area once or twice a day until improvement occurs". The SmPC carries no alopecia areata indication and states no 3 to 6 month course; that is from the dermatology guideline, which is not held in this corpus. · British Association of Dermatologists living guideline for managing people with alopecia areata 2024 (Br J Dermatol 2025;192:190-205) · Regaine 5% Cutaneous Solution SmPC section 4.2 (eMC product 5765)

Verified against4 documents

British Association of Dermatologists living guideline for managing people with alopecia areata 2024 (Br J Dermatol 2025;192:190-205) for the indication, with the product and its application from Dermovate (clobetasol propionate 0.05%) Cream SmPC section 4.2 (eMC product 939): "Apply thinly and gently rub in using only enough to cover the entire affected area once or twice a day until improvement occurs". The SmPC carries no alopecia areata indication and states no 3 to 6 month course; that is from the dermatology guideline, which is not held in this corpus.
British Association of Dermatologists living guideline for managing people with alopecia areata 2024 (Br J Dermatol 2025;192:190-205)
Regaine 5% Cutaneous Solution SmPC section 4.2 (eMC product 5765)
Egyptian National Drug Formulary (endf-endocrine.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (3)

Hair loss develops as localized bald patches on the scalp appearing over a period of weeks [hair loss]
Hair loss can also involve the beard, eyebrows, eyelashes, or limbs [hair loss]
Disease can progress to total scalp hair loss or, rarely, total body hair loss [hair loss]

Signs — what you find (7)

Exclamation-mark hairs, narrower at the base than the tip, at the edge of patches is a pathognomonic finding
Ophiasis pattern involves hair loss limited to the back of the scalp [hair loss]
Sisaipho pattern affects the front, temples and crown while sparing the back of the scalp
Diffuse pattern shows fast widespread shedding that regrows within months
About 10 to 15 percent of patients have nail changes such as fine pitting, trachyonychia, or onycholysis [nail changes]
White hairs tend to be spared, which can look like sudden greying at first
New patches often show only mild redness of the underlying skin [redness]

Tests (6)

Dermoscopy is a useful adjunct for confirming the diagnosis
On dermoscopy, broken hairs, yellow and black dots, and short vellus hairs signal early regrowth
A positive hair pull test confirms the hair loss is still active
Biopsy from the edge of an active patch is used when the diagnosis stays unclear
Missing hair follicles on exam points to scarring alopecia instead
Routine screening for other autoimmune disease is not advised unless the history points to it

If not this — what else fits (7)

Androgenetic alopecia (pattern baldness) is a mimic to rule out
Traction alopecia from hairstyling tension can look similar
Trichotillomania, or compulsive hair-pulling, belongs on the differential
Tinea capitis, a fungal scalp infection, can mimic patchy hair loss
Secondary syphilis can cause a similar patchy alopecia
Aplasia cutis congenita is another condition to distinguish
Temporal triangular alopecia is a further mimic to consider

SourceStatPearls "Alopecia Areata" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Topical | Intralesional

MAIN TREATMENT

BETAMETHASONE DIPROPIONATE

1st line

Formtopical

Adult dose and duration

Apply 0.05% cream or ointment thinly to bald patches once daily x 3-6 months once daily, then judge. Stopping at 3 months is early - the guideline's window runs to 6

Paediatric dose

Children and young people: 6 weeks on, 6 weeks off, then a further 6 weeks. That cycle is what the guideline recommends rather than continuous use, and it applies to a potent or a very potent steroid.

Dose source

British Association of Dermatologists living guideline for managing people with alopecia areata 2024 (Br J Dermatol 2025;192:190-205)

Why

A potent topical corticosteroid to the patches is the first-line option in primary care. Most limited patchy disease also remits without any treatment within a year, so watchful waiting is a legitimate alternative to offer.

Cautions

Counsel before starting if the skin is Fitzpatrick V or VI - which is most of this clinic. Topical and intralesional corticosteroids carry an increased risk of depigmentation in darker skin, including localised hypo- or hyperpigmentation and frank vitiligo. A patch of pale skin where the bald patch was is not a better outcome, and the patient decides whether that trade is worth making.
Refer to dermatology for extensive, rapidly progressive, or total scalp or body hair loss, and for any child with more than limited patchy disease.
Skin atrophy and telangiectasia with prolonged use - stop at 3 months if there is no regrowth.
Do not apply near the eyes; scalp application should avoid running onto the eyelids.
Check for associated autoimmune disease, particularly thyroid disease, vitiligo and coeliac disease.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
DIPROSONE 0.05% CREAM 10 GM	MEMPHIS	26.00 EGP
DIPROSONE 0.05% OINT. 10 GM	MEMPHIS	26.00 EGP
DIPROSONE 0.05% CREAM 30 GM	MEMPHIS	45.00 EGP

MINOXIDIL

add-on - not a substitute

Formtopical

Adult dose and duration

Apply 1 mL of 5% solution to the affected patches twice daily - at least 4-6 months before judging any effect

Paediatric dose

Not recommended in children.

Dose source

Regaine 5% Cutaneous Solution SmPC section 4.2 (eMC product 5765)

Why

Weak evidence in alopecia areata, unlike in pattern hair loss where it is first line. Offered only alongside a topical corticosteroid, never instead of one.

Cautions

Evidence in alopecia areata is limited - this is an add-on to a topical corticosteroid, not a treatment on its own.
Any regrowth is lost within 3-4 months of stopping.
Transient shedding in the first 2-6 weeks is expected and is not treatment failure.
In women, the 5% strength is licensed as a once-daily foam; the twice-daily 5% solution is the men's regimen. Twice-daily 5% solution in a woman raises the risk of facial hypertrichosis.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
MINOXIDIL FORTE 5% TOPICAL GEL 60 GM	EGPI > PHARMACARE	127.00 EGP

TOPICAL

CLOBETASOL PROPIONATE

Topical

2nd line

Formtopical

Adult dose and duration

Apply 0.05% cream or ointment thinly to resistant patches once daily x 3-6 months once daily, then judge

Paediatric dose

A very potent steroid is not off-limits in children here - the guideline puts potent and very potent together for scalp alopecia areata and gives both the same 6 weeks on, 6 weeks off, 6 weeks on cycle. Refer if the loss is extensive or spreading fast.

Dose source

Why

A very potent corticosteroid for patches that have not responded to a potent one. Intralesional triamcinolone is the other escalation and is a dermatology procedure.

Cautions

Counsel before starting if the skin is Fitzpatrick V or VI - which is most of this clinic. Topical and intralesional corticosteroids carry an increased risk of depigmentation in darker skin, including localised hypo- or hyperpigmentation and frank vitiligo. A patch of pale skin where the bald patch was is not a better outcome, and the patient decides whether that trade is worth making.
Very potent - not for use in children, on the face, or on large areas.
Skin atrophy occurs sooner than with a potent steroid; keep to the patches and set a stop date.
No regrowth after 3 months of a very potent steroid means referral, not a longer course.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
CLOBITAT 0.05% TOPICAL CREAM 15 GM	BIORIGINAL INTERNATIONAL GROUP PHARMA EGYPT	5.50 EGP
DERMASOL 0.05% CREAM 20 GM	UP PHARMA	5.50 EGP
DERMASOL 0.05% OINT. 20 GM	UP PHARMA	5.50 EGP
CLEROVATE 0.05% TOPICAL OINT. 25 GM	MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)	7.50 EGP
CLOVACORT 0.05% OINT. 20 GM	EUROPEAN EGYPTIAN PHARM. IND.	9.00 EGP
DERMOPHARM 0.05% CREAM 25 GM	WESTERN PHARMACEUTICALS INDUSTRIES	22.00 EGP
DERMOVATE 0.05% TOP. CREAM 25 GM	GLAXO SMITHKLINE	44.00 EGP
HEROBETASOL 120 MLSHAMPOO	EGPI > HEROPHARM	37.50 EGP

INTRALESIONAL

TRIAMCINOLONE

Intralesional

2nd line

Strength10 mg

Forminjection

Adult dose and duration

2-3 mg up to 5mg at one site. If several sites are injected the total dosage should not exceed 30 mg.

Paediatric dose

(For adults and children over 6 years: 2-3 mg up to 5 mg at one site; total dosage across several sites not to exceed 30 mg.)

Dose by age
Over 6 years:	2 to 3 mg, up to 5 mg, at one site. Total across several sites not to exceed 30 mg.

Dose source

Egyptian National Drug Formulary (endf-endocrine.txt)

Why

Intralesional corticosteroid injection for patchy alopecia areata.

Cautions

Hypersensitivity to Triamcinolone or any component of the formulation.
The site of injection and volume of injection should be carefully considered due to the potential for cutaneous atrophy.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
PHARCOCINOLONE 40MG/ML I.M AMP.? strength differs	CHEMIPHARM > PHARCO B	8.00 EGP
AMCINOL 40MG/ML I.M AMP.? strength differs	SIGMA TEC	11.00 EGP
EPIRELEFAN 40MG/ML I.M AMP.? strength differs	EIPICO	38.00 EGP
SYNTHECORTIN 40MG/ML I.M AMP.? strength differs	MUP	54.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.