# Alopecia areata (patchy hair loss) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Betamethasone dipropionate — topical - Clobetasol propionate — topical - Triamcinolone — 10 mg — injection - Minoxidil — topical ## Complete treatment card ```text ALOPECIA AREATA (PATCHY HAIR LOSS) 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) Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Alopecia Areata" - disease-level clinical article Status traced to the source above Rx: Main treatment | Topical | Intralesional MAIN TREATMENT 1. BETAMETHASONE DIPROPIONATE [1st line] Adult 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 Peds 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. 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. Caution 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. Egypt 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 2. MINOXIDIL [add-on - not a substitute] Adult Apply 1 mL of 5% solution to the affected patches twice daily - at least 4-6 months before judging any effect Peds Not recommended in children. 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. Caution 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. Egypt MINOXIDIL FORTE 5% TOPICAL GEL 60 GM EGPI > PHARMACARE 127.00 EGP TOPICAL 3. CLOBETASOL PROPIONATE [2nd line] Adult Apply 0.05% cream or ointment thinly to resistant patches once daily x 3-6 months once daily, then judge Peds 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. Source 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. 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. Caution 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. Egypt CLOBITAT 0.05% TOPICAL CREAM 15 GM BIORIGINAL INTERNATIONAL GROUP PHARMA... 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 EGYP... 9.00 EGP DERMOPHARM 0.05% CREAM 25 GM WESTERN PHARM... 22.00 EGP DERMOVATE 0.05% TOP. CREAM 25 GM GLAXO SMITHKLINE 44.00 EGP HEROBETASOL 120 MLSHAMPOO EGPI > HEROPHARM 37.50 EGP INTRALESIONAL 4. TRIAMCINOLONE [2nd line] Adult 2-3 mg up to 5mg at one site. If several sites are injected the total dosage should not exceed 30 mg. Peds Over 6 years: 2 to 3 mg, up to 5 mg, at one site. Total across several sites not to exceed 30 mg. (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.) Source Egyptian National Drug Formulary (endf-endocrine.txt) Why Intralesional corticosteroid injection for patchy alopecia areata. Caution 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. Egypt PHARCOCINOLONE 40MG/ML I.M AMP. CHEMIPHARM > ... 8.00 EGP [? strength differs] AMCINOL 40MG/ML I.M AMP. SIGMA TEC 11.00 EGP [? strength differs] EPIRELEFAN 40MG/ML I.M AMP. EIPICO 38.00 EGP [? strength differs] SYNTHECORTIN 40MG/ML I.M AMP. MUP 54.00 EGP [? strength differs] Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)