The effect of oral cyclosporine in the treatment of severe alopecia areata

Abstract

Context: Alopecia areata (AA) is a common non-scarring hair loss condition with an unpredictable and relapsing disease course. T-cell mediated autoimmune process is mainstay of the pathogenesis of AA, therefore immunosuppressive therapies are widely used in the treatment of AA.Objective: The aim of the study was to evaluate efficacy of oral cyclosporine therapy and reveal effects of prognostic factors in the treatment of severe AA.Materials and methods: We evaluated case histories of patients who were admitted to our department between December 2004 and September 2011 for the treatment of severe AA. A total of 25 patients were included in the study. Patients’ data that included sex, age, alopecia type, alopecia duration, family history, atopic history, previous treatments, treatment dosage, treatment duration, adverse events and clinical response were retrieved from patients’ records. Twelve patients had multifocal AA, nine patients had alopecia universalis and four patients had alopecia totalis. Patients were treated with 2.5–6 mg/kg/d doses of oral cyclosporine for 2–12 months.Results: The mean age of patients was 21.92 ± 3.56 (range: 19–34) years. All patients were male. The mean duration of disease was 8.3 ± 6.48 (range: 0.5–21) years. Four patients had positive family history and three patients had atopy history. Three of 25 (16%) patients discontinued treatment due to adverse events. Of remaining 22 patients, significant hair growth was observed in 10 (45.4%) patients; five patients with multifocal AA, three patients with alopecia universalis and two patients with alopecia totalis. In addition to this, six of nine patients with less than four years disease duration showed significant hair growth. But in patients with more than four years disease duration, only 4 of 13 patients showed significant hair growth.Conclusion: This study indicates that oral cyclosporine treatment may be a beneficial treatment option for severe AA. In addition to this, disease duration is an important prognostic factor that influences efficacy of oral cyclosporine treatment.