How do you manage alopecia areata in children with >50% of hair loss that is unresponsive to intralesional or topical steroids?

Treatment typically varies depending on the age of the child and the impact on the child's quality of life. Some options include adding topical minoxidil or compounded topical JAK inhibitors such as topical tofacitinib. In more severe cases, I offer oral minoxidil, monthly pulse prednisone, systemic...

I like the idea of trying topical minoxidil, which can be effective and is pretty safe. We can discuss oral minoxidil down the road. Thanks.