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

Nekma Meah, Dmitri Wall, Katherine York, Bevin Bhoyrul, Laita Bokhari, Daniel Asz Sigall, Wilma F. Bergfeld, Regina C. Betz, Ulrike Blume-Peytavi, Valerie Callender, Vijaya Chitreddy, Andrea Combalia, George Cotsarelis, Brittany Craiglow, Jeff Donovan, Samantha Eisman, Paul Farrant, Jack Green, Ramon Grimalt, Matthew HarriesMaria Hordinsky, Alan D. Irvine, Satoshi Itami, Victoria Jolliffe, Brett King, Won Soo Lee, Amy McMichael, Andrew Messenger, Paradi Mirmirani, Elise Olsen, Seth J. Orlow, Bianca Maria Piraccini, Adriana Rakowska, Pascal Reygagne, Janet L. Roberts, Lidia Rudnicka, Jerry Shapiro, Pooja Sharma, Antonella Tosti, Annika Vogt, Martin Wade, Leona Yip, Abraham Zlotogorski, Rodney Sinclair

Research output: Contribution to journalArticlepeer-review

111 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)123-130
Number of pages8
JournalJournal of the American Academy of Dermatology
Issue number1
StatePublished - Jul 2020

Bibliographical note

Funding Information:
The authors would like to acknowledge financial support from the Australasian Hair and Wool Research Society , and for resource support from National and International Skin Registry (NISR) Solutions not-for-profit company (Dublin, Ireland) and The City of Dublin Skin and Cancer Hospital Charity (Dublin, Ireland).

Publisher Copyright:
© 2020 American Academy of Dermatology, Inc.


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