The Alopecia Areata Consensus of Experts (ACE) study: Results of an international expert opinion on treatments for alopecia areata


Nekma Meah, Sinclair Dermatology
Dmitri Wall, Sinclair Dermatology
Katherine York, Netcare
Bevin Bhoyrul, Sinclair Dermatology
Laita Bokhari, Sinclair Dermatology
Daniel Asz Sigall, Dermalomas Clinic
Wilma F. Bergfeld, Cleveland Clinic Foundation
Regina C. Betz, Universitäts-Klinikum Bonn und Medizinische Fakultät
Ulrike Blume-Peytavi, Charité – Universitätsmedizin Berlin
Valerie Callender, Howard University College of Medicine
Vijaya Chitreddy, Sinclair Dermatology
Andrea Combalia, Hospital Clinic Barcelona
George Cotsarelis, University of Pennsylvania Perelman School of Medicine
Brittany Craiglow, Dermatology Physicians of Connecticut
Jeff Donovan, Donovan Hair Clinic
Samantha Eisman, Sinclair Dermatology
Paul Farrant, Brighton and Sussex University Hospitals NHS Trust
Jack Green, St. Vincent's Hospital Melbourne
Ramon Grimalt, Universitat Internacional de Catalunya
Matthew Harries, Salford Royal NHS Foundation Trust
Maria Hordinsky, M Health Fairview Discovery Pediatric Specialty Clinic
Alan D. Irvine, St James's Hospital
Satoshi Itami, Oita University
Victoria Jolliffe, Barts and The London School of Medicine and Dentistry
Brett King, Yale School of Medicine
Won Soo Lee, Yonsei University, Wonju College of Medicine
Amy McMichael, Wake Forest Baptist Medical Center
Andrew Messenger, The University of Sheffield
Paradi Mirmirani, Permanente Medical Group
Elise Olsen, Duke Dermatology Clinic
Seth J. Orlow, NYU Grossman School of Medicine
Bianca Maria Piraccini, Alma Mater Studiorum Università di Bologna
Adriana Rakowska, Medical University of Warsaw
Pascal Reygagne, Cabinet Pascal Reygagne (Lecourbe)

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Background: A systematic review failed to identify any systemic therapy used in alopecia areata (AA) where use is supported by robust evidence from high-quality randomized controlled trials. Objective: To produce an international consensus statement on the use and utility of various treatments for AA. Methods: Fifty hair experts from 5 continents were invited to participate in a 3-round Delphi process. Agreement of 66% or greater was considered consensus. Results: In the first round, consensus was achieved in 22 of 423 (5%) questions. After a face-to-face meeting in round 3, overall, consensus was achieved for only 130 (33%) treatment-specific questions. There was greater consensus for intralesional treatment of AA (19 [68%]) followed by topical treatment (25 [43%]). Consensus was achieved in 45 (36%) questions pertaining to systemic therapies in AA. The categories with the least consensus were phototherapy and nonprescription therapies. Limitations: The study included a comprehensive list of systemic treatments for AA but not all treatments used. Conclusion: Despite divergent opinions among experts, consensus was achieved on a number of pertinent questions. The concluding statement also highlights areas where expert consensus is lacking and where an international patient registry could enable further research.

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