Alopecia areata (AA) is an autoimmune disease characterized clinically by round to oval well-demarcated hair loss patches and pathologically by dense lymphocytic infiltration surrounding the bulbar portion of anagen hair follicles. However, these typical manifestations can be predominantly observed in the acute phase of the disease. In chronic phase, hair follicles shift from anagen to telogen phase in response to autoimmune reaction and little inflammation can be observed. In the acute phase, hair loss is mainly caused by the destruction of the bulbar portion of the anagen hair follicles, while, in the chronic phase, club hairs are predominantly shed due to dynamic transition of most affected hair follicles from anagen to telogen phase. As the pathophysiology of AA is distinct between acute and chronic phase, treatment planning needs to be optimized considering the condition of individual cases. Those with ongoing autoimmune-mediated hair loss can benefit from direct immunosuppression by means of corticosteroid (local injection, topical application or, for rapidly progressive cases, intravenous pulse therapy), while, for chronic phase patients, alternative approaches represented by the contact immunotherapy would be more favorable. Therapeutic outcomes can be further improved with careful evaluation and elucidation of major pathophysiology causing hair loss in each patient and the selection of optimal treatments with mode-of-action which would be ideal for respective conditions.

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Objective: With new topical treatment options, we aimed to investigate the current status of scalp psoriasis treatment, therapeutic effect, and patient satisfaction. Methods: A prospective observational study was conducted by multicenter questionnaire survey of patients with scalp psoriasis who initiated or switched topical medicines during 3 months prior to the start of the survey, and their physicians. Scalp lesions were treated topically for 3 months. Every month, the physicians were surveyed to assess therapeutic effect (e.g. PSSI), prescriptions, etc. and the patients were surveyed to determine satisfaction with treatment (TSQM-9), etc. Three months later, preferences for new versus old topical medicines (PPQ) were surveyed. Results: The status of treatment was investigated in 737 of the 766 enrolled patients with scalp psoriasis. Systemic therapies (oral medication, phototherapy, and biologics) were concomitantly performed in 297 patients (40.3%). Four-hundred-forty patients (59.7%) who received topical treatment alone formed the efficacy analysis set. In both groups, gel was used most frequently, in approximately 70%, followed by steroid lotion and shampoo. During the survey period, the scalp lesions improved over time. Topical treatment alone with gel and shampoo statistically significantly improved the PSSI and IGA. Switching from any topical medicine to gel also improved the PSSI and TSQM-9. Approximately 80% of the patients preferred gel over their previous topical medicines. Conclusion: Topical medicines chosen frequently in actual clinical practice for scalp psoriasis treatment are in gel form and suitable for applying to the scalp. Gel and shampoo as new dosage forms were rated highly by both patients and physicians. Analysis by topical medicine before switching was only possible for gel, and it demonstrated that switching from any topical medicine to gel improves therapeutic effect and satisfaction with treatment.

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