High-Potency Topical Corticosteroids Effective for Alopecia Areata in Children


FREE PREVIEW. AAFP members and paid subscribers: Log in to get free access. All others: Purchase online access.

FREE PREVIEW. Purchase online access to read the full version of this article.

Am Fam Physician. 2014 Jun 1;89(11):913.

Clinical Question

Are high-potency topical corticosteroids more effective than low-potency corticosteroids for alopecia areata in children?

Bottom Line

Clobetasol propionate, 0.05%, applied in a thin layer for six weeks on, six weeks off, is a highly effective and safe treatment for alopecia areata in children; hydrocortisone, 1%, is not. (Level of Evidence = 1b)


There are limited randomized controlled trial data regarding treatment of alopecia areata. In this trial, 41 children (age range = two to 16 years) who had at least 10% scalp involvement were randomized to receive a high-potency topical corticosteroid (clobetasol propionate, 0.05%) or a low-potency topical corticosteroid (hydrocortisone, 1%). Patients who used other corticosteroids, immunosuppressants, recent topical therapy, or recent light therapy were excluded. Patients, physicians, and outcome assessors were all masked to the treatment assignment. The cream was applied twice daily in a thin layer to the affected area for two cycles of six weeks on, six weeks off. The primary outcome was the surface area of hair loss as measured by a dermatologist masked to treatment assignment. The median baseline area of hair loss decreased from 72 cm to 3 cm in the high-potency group, and increased slightly from 49 cm to 55 cm in the low-potency group. A total of 85% of patients in the high-potency group showed at least a 50% reduction in surface area compared with 33% in the low-potency group (P < .001; number needed to treat = 2). In addition, there was a 96.5% reduction in scalp surface area affected by hair loss in the high-potency corticosteroid group compared with only 4.6% in the low-potency corticosteroid group (P = .002). The primary adverse effect was skin atrophy in one patient with extensive disease, which resolved during the off cycle. Urinary cortisol levels revealed no evidence of adrenal suppression.

Study design: Randomized controlled trial (double-blinded)

Funding source: Government

Allocation: Concealed

Setting: Outpatient (specialty)

Reference: Lenane P, Macarthur C, Parkin PC, et al. Clobetasol propionate, 0.05%, vs hydrocortisone, 1%, for alopecia areata in children: a randomized clinical trial. JAMA Dermatol.. 2014;150(1):47–50.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley- Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.


Want to use this article elsewhere? Get Permissions

Information From Industry

More in AFP

Editor's Collections

Related Content

More in Pubmed

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article