Treatment Of Severe Alopecia Areata Research Articles

Total Glucosides of Paeony Capsule Plus Compound Glycyrrhizin Tablets for the Treatment of Severe Alopecia Areata in Children: A Randomized Controlled Trial

Total glucosides of paeony capsule (TGPC) and compound glycyrrhizin tablets (CGT) are plant extracts of glycosides. We conducted this study to examine the efficacy and safety of TGPC plus CGT for severe alopecia areata in children. 117 subjects were randomly allocated into TGPC plus CGT group or CGT group. For consecutive 12 months, subjects were given oral TGPC and CGT or oral CGT alone. The outcome measures included score of alopecia areata severity, effective rate, and adverse events observed in the 3rd, 6th, and 12th month. We found that the scores of alopecia areata severity of both groups were significantly reduced, and the scores of treatment group were lower than those of control group; for effective rate, there was no statistical difference between the two groups in the 3rd month, while in the 6th and 12th months the treatment group was superior compared with control group; the incidence rate of adverse events between the two groups was not statistically different, and no severe adverse events were observed. In conclusion, TGPC plus CGT appears effective and safe for severe alopecia areata in children.

Safety and Efficacy of Adalimumab for the Treatment of Severe Alopecia Areata: Case Series of Three Patients

Current therapeutic options for extensive alopecia areata (AA) often lead to disappointing results. To study the efficacy and safety of adalimumab in patients with severe AA. This was a prospective, open-label, single-center, pilot study. Three subjects of the planned 10 were enrolled and received two weekly subcutaneous (SC) loading doses of adalimumab 80 mg followed by 40 mg SC every week for 6 months. Patients were evaluated for efficacy and safety on a monthly basis. Enrolment in this trial was stopped following publication of studies showing no improvement in patients with AA treated with tumor necrosis factor α antagonists. One patient had a favorable response to adalimumab, whereas the two other patients had no benefit from the therapy. Adalimumab was well tolerated by patients with AA. Adalimumab was well tolerated in patients with AA but did not induce clinically significant hair regrowth.

Prognostic factors in methylprednisolone pulse therapy for alopecia areata

Many treatments induce remission in patients with alopecia areata. Systemic steroids, for example, are effective in the treatment of severe alopecia areata but have many side-effects. To avoid these side-effects, high-dose bolus infusions of methylprednisolone have been used to treat severe alopecia areata. The purpose of this study was to evaluate the prognostic factors associated with pulse therapy and to establish proper indications for methylprednisolone pulse therapy. Seventy patients with severe alopecia areata were treated i.v. with methylprednisolone on 3 consecutive days. All of the patients had rapid and extensive hair loss with the bald area exceeding 50% of the scalp. Seventy percent of the patients showed terminal hair growth and 41.4% showed complete responses with acceptable cosmetic outcomes. The prognostic factors that influenced successful outcome were the disease duration before treatment and the type of alopecia areata. Based on these two factors, a good response was obtained for all types of alopecia areata with a duration of 3months or less before treatment and for the plurifocal type of alopecia areata with a duration of 4-6months. Methylprednisolone pulse therapy is indicated for those alopecia areata patients who fall within our good response group.

Could azathioprine be considered as a therapeutic alternative in the treatment of alopecia areata? A pilot study

Alopecia areata is an autoimmune disease resulting in partial or total nonscarring hair loss and the treatment of severe alopecia areata is difficult. The aim of this study was to evaluate the efficacy and safety of azathioprine as a systemic monotherapy for moderate to severe alopecia areata. A total of 20 patients [14 men (70%) and six women (30%)] with minimum 6 months history of alopecia areata were included. The extent of scalp hair regrowth during and after the completion of the 6 months treatment was evaluated by the Severity of Alopecia Tool (the SALT score). The daily drug intake was calculated as 2 mg/kg of body weight. Mean duration of current episode of scalp hair loss was 26.4 (26.4 ± 17) months. Mean regrowth percentage was 52.3% (52.3 ± 38.4). Mean hair loss percentage before treatment was 72.7% (72.7 ± 28.3) compared with 33.5% (33.5 ± 30.7) after 6 months of azathioprine treatment. This showed a highly significant statistical difference (Paired t-test, CI 95% =21.5-54.1). Mean hair loss score (S(0) -S(5) ) before treatment was 3.9 (3.9 ± 1.6) and after 6 months of azathioprine treatment was 1.8 (1.8 ± 1.3). Assessment showed significant difference from baseline score (sign test, P < 0.0001). No significant statistical difference was observed with respect to gender before and after azathioprine treatment. Treatment with azathioprine as a systemic monotherapy clinically produces relevant improvement in moderate-to-severe alopecia areata. Generally azathioprine is a low-cost and well-tolerated drug and with controlled studies on larger number of patients, long-term efficacy and safety of this treatment should be investigated.

Alefacept for Severe Alopecia Areata

To assess the efficacy of alefacept for the treatment of severe alopecia areata (AA). Multicenter, double-blind, randomized, placebo-controlled clinical trial. Academic departments of dermatology in the United States. Forty-five individuals with chronic and severe AA affecting 50% to 95% of the scalp hair and resistant to previous therapies. Intervention Alefacept, a US Food and Drug Administration-approved T-cell biologic inhibitor for the treatment of moderate to severe plaque psoriasis. Main Outcome Measure Improved Severity of Alopecia Tool (SALT) score over 24 weeks. Participants receiving alefacept for 12 consecutive weeks demonstrated no statistically significant improvement in AA when compared with a well-matched placebo-receiving group (P = .70). Conclusion Alefacept is ineffective for the treatment of severe AA.

The efficacy of topical diphencyprone in the treatment of alopecia areata

Sir, In a retrospective study, 54 patients (38 females and 16 males) with chronic extensive alopecia areata, who had used diphencyprone (DPCP) for more than 1.5 years, between January of 2001 and December of 2005, were studied. The extent of hair loss was severe (>75%), moderate (26-75%), and mild (<25%) in 68.5%, 29.6%, and 1.9% of them, respectively. The mean duration of the disease was 7.8 ± 8.1 years. The patients were sensitized initially with a 2% solution of DPCP in acetone, which was applied to a 5-centimeter-diameter circular area on the scalp. Treatment started two weeks after sensitization with 0.001% DPCP, on one-half of the patient's scalp. The concentration of the solution used was increased stepwise (0.01%, 0.1%, 0.2%, 0.5%, 1% and 2%) until redness, pruritus, but without vesicular eruption maintained. The patients were instructed to avoid direct exposure of the scalp to sun and not to wash the scalp for 48 hours after DPCP treatment. If terminal hair growth was noted, the entire scalp was treated under the same weekly protocol. Terminal hair regrowth on the scalp was excellent (76-100%) in 40.7%, good (51-75%) in 14.8%, moderate (26-50%) in 14.8%, and mild (<25%) in 29.6% of patients [Figures 1–3]. Figure 1 (a) 12 months after treatment; (b) 15 months after treatment; (c) 18 months after treatment Figure 2 (a) Before treatment; (b) Six months after treatment Figure 3 (a) 3 months after sensitization; (b) 3.5 months after sensitization; (c) 5 months after sensitization; (d) 7.5 month after sensitization Sixty two percent of the patients, with a duration of ≤10 years, had good and/or excellent response to the treatment (P = 0.017). There was no relationship between response to treatment and sex, onset of disease, nail involvement, atopy, extent of hair loss, and family history of alopecia areata. During the treatment, 33% of the patients experienced relapse. Continuation of the DPCP therapy caused hair re-growth in 21 of them. Adverse effects included contact dermatitis on the face or neck (five of 54), hyperpigmentation (four of 54) and occipital lymphadenopathy (one of 54). In this study, the response to the treatment in 55.5% of the patients was appropriate. In other reports, however, the percentage of success varied greatly from four to 85%.[1] The changes in response rates may be due to the number of patients in trials, the type, duration and severity of the alopecia areata, and different methods of assessing clinical efficacy. In addition, in our study, duration of disease was the only predictor for response rate. The presence of nail changes, a personal history of atopy, long duration of alopecia before treatment, baseline extent of alopecia, age at disease onset and duration of treatment have been considered as prognostic factors in other studies.[2 4] It seems that the topical DPCP in the treatment of severe alopecia areata is effective, but with a slightly high relapse rate during treatment. Duration of the disease, less than 10 years, is a main predictor for this response rate.

A combination of ciclosporin and methylprednisolone may be useful for the treatment of severe alopecia areata,

A combination of ciclosporin and methylprednisolone may be useful for the treatment of severe alopecia areata,

Treatment of Severe Alopecia Areata: Combination Therapy Using Systemic Cyclosporine A with Low Dose Corticosteroids.

Combination therapy using cyclosporine A (CsA) together with low-dose corticosteroids has adequate efficacy with little toxicity for the treatment of severe alopecia areata (AA). We wanted to evaluate the clinical efficacy of combination therapy using CsA with low-dose corticosteroid for the treatment of severe AA and we also wanted to determine the safe therapeutic concentration of CsA in the peripheral blood. We treated 34 cases of severe AA with combination therapy for 24 weeks and we evaluated the efficacy at 12 and 24 weeks. We monitored the peripheral blood concentration of CsA to determine the therapeutic range of CsA that has the fewest side effects. Of the patients, 77.4% (n=24) and 22.6% (n=10) were classified in the responder and poor-responder groups, respectively. The mean trough concentration of CsA was 95.1 and 101.2 ng/ml in the responder and poor-responder groups, respectively. For the patients with side effects associated with CsA, the mean CsA concentration was 195.8 ng/ml. We found that combination therapy with systemic CsA and low-dose corticosteroids effectively treats severe AA and this therapy results in a safe, therapeutic concentration of CsA in the peripheral blood.

The use of methotrexate alone or in combination with low doses of oral corticosteroids in the treatment of alopecia totalis or universalis

Treatment of severe alopecia areata (AA) remains difficult. To assess the tolerance and efficacy of methotrexate (MTX) in the treatment of severe long-term AA, we retrospectively evaluated 22 patients with AA totalis or universalis with a mean duration of 11.0 +/- 8.8 years who were treated with MTX either alone (n = 6) or associated with low doses of oral prednisone (n = 16). MTX was given at an initial weekly dosage of 15 mg (n = 3), 20 mg (n = 9), or 25 mg (n = 10). Oral prednisone was given at an initial dosage of 10 mg/d in one patient and 20 mg/d in 15 patients. In all, 14 patients (64%) achieved a total recovery including 3 of 6 patients treated by MTX alone and 11 of 16 who had received the combined treatment. Of the 14 patients who had total hair regrowth, 6 stopped MTX. In all, 3 patients maintained hair regrowth and 3 relapsed. Retreatment of these 3 patients by MTX resulted again in hair regrowth. No severe side effect was observed. Although limited by its uncontrolled character, this study shows that MTX and low doses of oral corticosteroids may be an effective and well-tolerated treatment for severe types of AA.

Topical immunomodulator therapy with squaric acid dibutylester (SADBE) is effective treatment for severe alopecia areata (AA): Results of an open‐label, paired‐comparison, clinical trial

Severe alopecia areata (AA) may have a chronic relapsing course and is often resistant to current treatments. Objectives: The aim of our study was to evaluate whether topical immunotherapy with squaric acid dibutylester (SADBE) is able to improve the course of severe AA and to reduce the severity of relapses. Methods: Fifty‐four patients affected by severe AA treated with SADBE who were followed for a period of at least 2 years were selected as the study group. Data collected were compared with those of a matched control group of 54 patients who did not receive any treatment. Student's t‐test, analysis of variance (ANOVA) and Pearson's chi‐squared test were utilized for data analysis. Results: At the end of therapy, in comparison with the control group, the treatment group showed a statistically significant (p<0.001) improvement. At follow‐up, there was no significant change in relapse rate (treated 44% vs control 52%). However, relapses in the treated group were significantly less severe compared with the control group (p<0.001). Conclutions: Our data suggest that topical SADBE represents a valid therapeutic option in severe AA, and may prove to be disease modifying.

Sulfasalazine for alopecia areata

Sulfasalazine is used as a therapy for various autoimmune conditions, including psoriasis; its effectiveness is presumed to be the result of its immunomodulatory effects. We have treated patients with severe alopecia areata with sulfasalazine as part of our dermatology practice and have noticed cosmetically acceptable regrowth in 23% of patients in whom a response could be determined. In view of its good safety profile, sulfasalazine may be considered for systemic treatment of severe alopecia areata. (J Am Acad Dermatol 2002;46:541-4.)

High-Dose Pulse Corticosteroid Therapy in the Treatment of Severe Alopecia areata

Objective: The present monocenter prospective study was designed to evaluate the efficacy of intravenous high-dose methylprednisolone pulse therapy in patients with severe alopecia areata (AA). Methods: 30 patients (aged 14–56 years) were treated with methylprednisolone (8 mg/kg body weight) intravenously on 3 consecutive days at 4-week intervals for at least 3 courses. Results: 67% of patients with AA plurifocalis showed >50% regrowth of hair. None of the patients with AA totalis or universalis and only 1 patient with ophiasic AA responded to therapy. In patients with AA plurifocalis, higher response rates could be observed in those suffering from long-term disease compared to patients treated during their first episodes of AA (73 vs. 57%). Conclusion: High-dose methylprednisolone pulse therapy is an effective and well-tolerated treatment for patients with severe AA plurifocalis but might be less beneficial for patients with ophiasic AA, AA totalis or universalis.

Pulse methylprednisolone therapy for severe alopecia areata: An open prospective study of 45 patients

Background: Oral corticosteroids may be effective in the treatment of severe alopecia areata (AA), but the side effects of prolonged therapy limit their use. The benefit of a single intravenous pulse of methylprednisolone has not been evaluated in patients with ongoing hair loss of less than 12 months’ duration. Objective: Our purpose was to determine the effectiveness of an intravenous pulse of methylprednisolone at 1, 3, 6, and 12 months in patients with active severe AA of less than 12 months’ duration. Methods: Forty-five patients were included in this open study. All had rapid and extensive hair loss for less than 1 year (first occurrence or relapse), with the bald area exceeding 30% of the scalp. There were 20 multifocal, 10 ophiasic, 9 universalis, and 6 totalis cases. Intravenous methylprednisolone, 250 mg, was administered twice a day on 3 successive days. Follow-up for at least 12 months (up to 29 months) was performed. The percentage of pretreatment bald area covered by hair regrowth at 1, 3, 6, and 12 months was measured. Results: No major side effects were observed. Patients with multifocal AA (n = 20) showed the best response rate, with 9, 12, 13, and 12 showing 100% or 50% to 100% regrowth at 1, 3, 6, and 12 months, respectively. Relapse occurred at 3 months in 1 patient, at 6 months in 2, and at 12 months in 4. A second pulse was tried in 2 patients with relapse with 100% regrowth that was stable at 12 and 28 months. In patients with ophiasic AA (n = 10), no total regrowth was observed; 6 had no response, 4 showed 20% to 70% regrowth at 1 month with relapse at 3 and 6 months. A second series of pulses was given to the 4 initial responders 3 to 13 months after the first series; the response rate to this second treatment was better than the first. In patients with universalis and totalis AA (n = 15), no total regrowth was observed initially; 8 patients had no response, and 3 showed 50% to 90% regrowth at 1 month, with subsequent improvement at 3 and 6 months. In 4 patients who did not show an initial response, a significant (90% to 100%) delayed regrowth was observed between 9 and 16 months after the pulse therapy. Conclusion: A single series of intravenous pulse of methylprednisolone appears to be well tolerated and effective in patients with rapidly progressing extensive multifocal AA, but not those with ophiasic and universalis AA. (J Am Acad Dermatol 1998;39:597-602.)

Severe alopecia areata treated with systemic corticosteroids.

Treatment of severe alopecia areata is difficult, and most efforts to successfully treat this condition have been disappointing. Systemic corticosteroids have been demonstrated as an effective treatment of severe alopecia areata. Eighteen patients with alopecia areata (extensive patchy and totalis universalis types) were treated with systemic corticosteroids. Satisfactory hair regrowth was achieved in seven patients (38.9%). Hair fall subsequently occurred in all of these patients on discontinuation or tapering of corticosteroid therapy. Systemic corticosteroid therapy does not prevent the spread or relapse of severe alopecia areata and, when complete regrowth is obtained, it is rarely maintained off therapy.

Topical Immunotherapy of Severe Alopecia areata with Diphenylcyclopropenone: Evaluation of 68 Cases

Background: Currently, topical immunotherapy with diphenylcyclopropenone (DCP) represents the most accepted therapeutic modality in the treatment of severe alopecia areata (AA). Objective: Efficacy, side effects and prognostic factors of DCP treatment in severe AA. Methods: Retrospective study of 68 patients with severe AA (>40% scalp hair loss), treated for at least 5 months at the Department of Dermatology, University Hospital of Zürich, between May 1989 and December 1996. Results: The overall response rate was 70.6%, complete remission was obtained in 30.9% and partial remission in 39.7%. Among the investigated prognostic factors for the outcome of DCP therapy, only the extent of AA at the time of initiation of treatment was found to be of significance. Conclusion: DCP treatment of severe AA is an effective, albeit symptomatic therapy with frequent side effects and a relatively high relapse rate. The response rate depends on the type of AA.

Treatment of Severe Alopecia Areata with Topical Diphenylcyclopropenone and 5% Minoxidil: A Clinical and Immunopathologic Evaluation

Treatment of Severe Alopecia Areata with Topical Diphenylcyclopropenone and 5% Minoxidil: A Clinical and Immunopathologic Evaluation

Treatment of Severe Alopecia Areata with Squaric Acid Dibutylester in Pediatric Patients

Topical squaric dibutylester (SADBE) is currently used in Europe to treat alopecia areata in adults. We attempted to determine this drug's effectiveness and convenience in treating children with severe alopecia areata who are psychologically disturbed and resistant to other therapies. Twenty-eight children under 13 years of age who had extensive and long-standing alopecia areata and were not responsive to conventional therapies were sensitized on the head with 2% SADBE in acetone and treated with weekly applications for 12 months. Nine patients (32.1%) achieved complete or cosmetically acceptable regrowth, and another six (21.4%) had significant regrowth. No correlation was found between response and sex, age of onset of illness, extent, duration, or clinical type of disease. In 14 patients followed for a period ranging from 18 months to 8 years SADBE remained efficacious for relapses as well. This study demonstrates that SADBE is a valid and suitable treatment for children, particularly those who are resistant to conventional therapies.

Topical Immunotherapy in the Treatment of Chronic Severe Alopecia Areata

In the past decade, topical immunotherapy with DPCP has been shown to be a very important therapeutic modality in the treatment of chronic severe alopecia areata. At the University of British Columbia Hair Clinic, it is our treatment of choice in adults. This option for treatment should be offered to the appropriate patients.

PUVA treatment for alopecia areata--does it work? A retrospective review of 102 cases.

The results of PUVA treatment for severe alopecia areata (AA) were reviewed in 102 patients. Fifty-three per cent had greater than 90% regrowth of hair. Although these results appear to be encouraging, they differ little from what would be expected with no treatment. We consider that PUVA is not an effective treatment for AA.