Accepted for/Published in: JMIR Dermatology
Date Submitted: Dec 15, 2025
Date Accepted: Aug 27, 2026
Current Management and Unmet Needs in Alopecia Areata – A Narrative Review from a Malaysian Perspective
ABSTRACT
Background:
Alopecia areata (AA) is a chronic autoimmune disorder characterized by non-scarring hair loss. Although reports indicate a rising global frequency, Malaysia remains underrepresented in epidemiological studies.
Objective:
The objective of this narrative review was to use Malaysian data as a case study within a broader context to identify key unmet needs in AA management.
Methods:
A comprehensive literature search was conducted using PubMed, Embase, and Scopus, supplemented by grey literature sourced via Google. The Malaysian Journal of Dermatology was hand-searched for local studies. The search aimed to identify studies relevant to the epidemiology, clinical burden, current management practices, and unmet needs of AA, specifically focusing on the Malaysian context. Additionally, a semi-systematic search was utilized to obtain a broader contextual understanding of the global epidemiology and recent trends in the management of AA.
Results:
A particularly notable upward trend in the frequency of AA and severe disease in pediatric cohorts is evident in Asian populations. Although there are few Malaysian studies on AA, the data aligns with global trends in ethnic variation, with higher rates observed among Malays and Indians than Chinese. Overall, the psychosocial burden of AA is high in Malaysia, including elevated anxiety and depression rates among younger and unmarried patients. Local management relies heavily on corticosteroids (topical, followed by intralesional and oral), other topical agents (minoxidil, salicylic acid, acetic acid and tacrolimus) and phototherapy, and the adoption of Janus kinase (JAK) inhibitors in severe disease is hampered by substantial out-of-pocket expenses, which impede equitable care. This highlights the necessity for wider access to novel therapies.
Conclusions:
Despite growing awareness of AA and its impact, critical gaps persist in epidemiological data, clinical characterization, and treatment access in Malaysia. The considerable effect on quality of life emphasizes the need for robust nationwide epidemiology, improved patient support, and development of locally relevant, comprehensive management guidelines. Clinical Trial: Not applicableAlopecia; alopecia areata; Malaysia; reimbursement; JAK inhibitors
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