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.     

Alopecia areata in Turkey: demographic and clinical features

Background  Alopecia areata is a complex genetic disease with still many unknown aspects, and many studies have been tried to find some clues about it.
Objective  We aimed to investigate the demographic and clinical characteristics of alopecia areata in Turkish patients.
Methods  Demographic data, localization, attack number in addition to some parameters such as disease duration, severity, age of onset, family history and ophiasis pattern were evaluated in 539 alopecia areata patients.
Results  The male to female ratio was 1.6 : 1. Occipital and beard-moustache areas were mostly affected. Positive family history was noticed in 24.1% of the patients. The age of onset was earlier in women than in men ( P =  0.04). Severe forms showed more persistent (≥ 1 year) disease duration ( P =  0.00). Ophiasis was more common in severe, long duration (≥ 1 year) and early onset (≤ 18 years) disease ( P =  0.00 for all parameters). Childhood alopecia areata (≤ 18 years) was also associated with long duration of the disease ( P =  0.016) and positive family history ( P =  0.008) when compared with adult onset (> 18 years) alopecia areata.     

308-nm Excimer Laser for the Treatment of Alopecia Areata in Children

Abstract:  Alopecia areata (AA) is a common skin disease which is characterized by nonscarring localized or diffused hair loss. In this study we assessed the efficacy of 308-nm Excimer laser in the treatment of alopecia areata in children. A total of 9 children with 30 recalcitrant patches alopecia areata and two children with alopecia areata totalis were enrolled in this study which included seven male and four female patients, aged between 4 and 14 years and the durations of their disease were between 7 and 25 months. All of these patients had more than one lesion of alopecia areata and at least one of them was left as a control for comparison. The lesions were treated with the 308-nm Excimer laser twice a week for a period of 12 weeks. Regrowth of hair was observed in 18 (60%) alopecia patches in the scalp, while there was no response in the control patches and over the extremities. Only four patients with scalp lesions showed a recurrence of alopecia after 6 months post laser therapy. So, 308-nm Excimer laser is considered an effective safe therapeutic option for patchy alopecia areata in children.     

Intravenous pulse methylprednisolone therapy for severe alopecia areata: an open study of 66 patients

INTRODUCTION: Treatment of alopecia areata is a difficult challenge. Some European publications have shown encouraging results with high dose pulse corticosteroid therapy in extensive plurifocal alopecia areata. We undertook a prospective open study between January 2000 and December 2001 using repeated pulse each month, with the aim of identifying the effects of this repetition and underlining the best indications. PATIENTS AND METHODS: Sixty-six patients aged 9 to 60 years old presenting an extensive alopecia areata exceeding 30% of the scalp surface (n=47), alopecia totalis (n=8), alopecia universalis (n=8), ophiasic alopecia (n=3), for less than 12 months entered this study. The administered treatment was methylprednisolone 500 mg/d during 3 days or 5 mg/kg twice per day during 3 days in children. These pulses were repeated after 4 and 8 weeks, then a second series was carried out or not according to cases. The main evaluation criterion was the percentage of new terminal hair appearing on the bald areas, appreciated by clinical and photographic evaluation at 3 and 6 months. RESULTS: Ophiasic alopecia areata did not respond to treatment. A quarter of patients presenting universal alopecia had a good response (higher than 80 p. 100) followed by a relapse in half the cases. Half of the patients presenting alopecia totalis had a good response, which was maintained three times out of four. Multifocal alopecia areata seems the best indication since the patients under study presented a good response in 63.8 p. 100 of cases (78 p. 100 when it was a first episode and 90.5 p. 100 if the treatment had been started in less than 3 months before). The repetition of the pulses did not appear to increase the number of responders. CONCLUSION: This study provides the best indication of pulse methylprednisolone therapy: first recent episode of extensive plurifocal alopecia areata. These results are less convincing in long term history or other forms of alopecia areata.     

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.     

Treatment of alopecia areata with squaric acid dibutylester

Fourteen of 18 patients with extensive alopecia areata completed a course of weekly treatments with the topical allergen squaric acid dibutylester in acetone. The concentration of squaric acid was varied as needed to maintain a moderate dermatitis. Only one area of alopecia was treated in each patient until marked hair growth occurred. The remainder of the scalp was then treated. Four patients (28.5%) had complete regrowth of hair during treatment; one of these patients had recurrent alopecia after stopping treatment. Ten patients (71.4%) were treatment failures. Of these ten failures, seven developed a moderate dermatitis and hair regrowth but experienced recurrent alopecia with continued treatment. One patient failed to maintain an adequate persistent dermatitis, and two failed to grow any hair despite the presence of dermatitis. Successful results in these patients correlated with (1) a duration of alopecia of less than two years, (2) the development of a moderate dermatitis within three weeks of starting treatment, (3) persistent hair growth within two months of developing dermatitis, and (4) an age of 16 years or older.     

Efficacy and safety of methotrexate in alopecia areata

BACKGROUND

Alopecia areata is a chronic disorder of the hair follicles and nails, of unknown etiology, with clear autoimmune components and genetic factors. Several therapeutic options have been suggested; however, no treatment is able to modify the disease course. Methotrexate is an immunosuppressant used in various dermatoses and recently introduced as a therapeutic option for alopecia areata.

OBJECTIVES

To evaluate the efficacy and safety of methotrexate in alopecia areata.

METHODS

In a retrospective, non-controlled study, we evaluated 31 patients with alopecia areata in current or prior treatment with methotrexate to assess the therapeutic response according to sex, age, pattern of alopecia areata, disease duration, cumulative dose of methotrexate, use of systemic corticosteroids or other treatments, and drug safety.

RESULTS

Regrowth greater than 50% was observed in 67.7% of patients, with the best responses observed in those with <5 years of disease progression (79%), age over 40 years (73.3%), male patients (72.8%), cumulative dose of methotrexate 1000-1500 mg, and multifocal alopecia areata (93%). Among patients receiving systemic corticosteroids in combination with methotrexate, 77.3% had greater than 50% regrowth, compared with 44.4% in those who used methotrexate alone. The therapeutic dose ranged from 10-25 mg/week. No patient had serious adverse effects. Relapse was observed in 33.3% of patients with more than 50% regrowth.

CONCLUSION

Methotrexate appears to be a promising and safe medication for the treatment of severe alopecia areata when used alone or in combination with corticosteroids.     

TREATMENT OF ALOPECIA AREATA WITH DIPHENCYPRONE

Forty-five patients with extensive alopecia areata were treated by local application of diphencyprone. Only eleven had satisfactory regrowth of hair. Six had moderate regrowth, and of the remaining 28 some showed regrowth of vellus hair and others had no response. The side effects of the treatment consisted of intense allergic or irritant reactions, febrile reactions, anaphylactic reaction with fainting, and vitiligo. In twelve patients progressive desensitisation was observed. As the effectiveness of this treatment is low and side effects are common and sometimes severe, we conclude that diphencyprone has no advantage in the treatment of alopecia areata.     

The use of topical diphenylcyclopropenone for the treatment of extensive alopecia areata

BACKGROUND: Highly variable results of topical diphenylcyclopropenone (DPCP) in the treatment of alopecia areata have been reported so far. OBJECTIVE: The purposes of our study were to evaluate the efficacy and tolerability of DPCP in the treatment of chronic, extensive alopecia areata and to assess the long-term overall benefit of treatment. METHODS: Fifty-six patients with chronic, extensive alopecia areata were enrolled in an open-label clinical trial. After sensitization with 2% DPCP, progressively higher concentrations beginning at 0.001% were applied weekly for 6 to 12 months to one side of the scalp. RESULTS: Fifty-two of 56 patients completed therapy. Total regrowth of terminal hair was achieved in 25 of 52 patients (48%) at 6 months. The most frequent side effect was an eczematous reaction at the site of application. Notably, persistent response was observed in 60% of these patients after 6 to 18 months of follow-up (mean, 12 months). CONCLUSION: Topical DPCP treatment for alopecia areata is effective and well tolerated and provides prolonged therapeutic benefits.     

The pattern and profile of alopecia areata in Singapore--a study of 219 Asians

BACKGROUND: Alopecia areata is believed to be an autoimmune condition with a worldwide occurrence. It usually presents as patchy, nonscarring hair loss. There is a paucity of clinical data in Asians. OBJECTIVE: To study the epidemiology, clinical aspects, associations, and treatment of alopecia areata in an Asian population over a 1-year period. METHODS: Records of all newly diagnosed alopecia areata cases seen from May 1998 to April 1999 at the National Skin Center were collated with regard to the epidemiology, pattern of alopecia, and associations according to the investigational guidelines published by Oslen et al. The treatment and psychologic impact of alopecia areata were also assessed. RESULTS: Two hundred and nineteen new case referrals of alopecia areata were seen from May 1998 to April 1999. The incidence of alopecia areata was 3.8%. There were 173 Chinese (79%), 35 Indians (16%), and 11 Malays (5.0%). The male to female ratio was 1 : 1.3. The median age at presentation was 25.2 years. The majority of patients (85.5%) had their first episode of alopecia areata before the age of 40 years. Of the patients with onset of alopecia areata before the age of 40 years, 36.5% presented with extensive alopecia, compared with 5.5% above the age of 40 years (P < 0.05). Nail changes, consisting of pitting, trachyonychia, and longitudinal ridging, were reported in 23 patients (10.5%). A significant percentage of patients had an associated personal and family history of atopy (60.7%). There was no significant association between a personal history of atopy and the extent of alopecia areata. The frequencies reported for the following associated diseases were: thyroid disease, 2.3%; vitiligo, 4.1%; diabetes mellitus, 3.2%; Down's syndrome, 1.4%; and rheumatic arthritis, 0.9%. A family history of alopecia areata was reported in 4.6%. Intralesional triamcinolone acetonide was the first-line treatment for limited alopecia areata, while squaric acid dibutyl ester was used for extensive involvement. The majority of patients with limited alopecia areata (82.1%) had more than 50% improvement with intralesional triamcinolone acetonide after 3 months. The majority of patients who received squaric acid dibutyl ester (87.5%) achieved more than 50% regrowth at the end of 6 months. Poor prognostic factors for alopecia areata were extensive involvement, early age of onset, and Down's syndrome. Thirteen out of 132 respondents (9.8%) recalled stressful events preceding hair loss. Patients with extensive alopecia areata experienced more psychologic adverse effects than those with limited alopecia areata (P < 0.05). Males with extensive alopecia areata experienced more severe psychologic ill-effects, such as depression and feelings of inability to improve hair loss. CONCLUSIONS: Our findings are similar to those reported in the Western literature where alopecia areata is predominantly a disease of the young. A holistic approach is important in the management of alopecia areata as the disease can have a severe psychologic impact on an individual's well-being.     

Epidemiología clínica de la alopecia areata

. —Since Ikeda described in 1965 her four clinical forms of alopecia areata (common, atopic, prehypertensive, combined), several epidemiological studies have deepened in the knowledge of this disease, confirming or questioning many of the initial findings. The series of cases made with inpatient samples can overlue the frequency of severe forms (total and universal alopecia) and the prognosis of alopecia areata. Studies carried out in general population gives an incidence of 20.2 new cases/100,000 people/year, and a lifetime-prevalence figure of 1.7%. Slight and moderate cases are frequent, developing a total/universal alopecia in the evolution only 7% of patients. It was described also a distribution of uniform beginning of alopecia areata in all ages, and a gender- ratio next to 1:1. Finally, current genetic studies and clinical- epidemiological ones have found two clinical forms of disease («genetic» or severe, and «benign» or stress-related), with different HLA markers, evolution, clinical presentation and relationship with psychosocial stress. However, more population studies than clarify some unclear features of disease are needed.     

Twice weekly 5 mg dexamethasone oral pulse in the treatment of extensive alopecia areata.

Thirty patients (20 males, 10 females) with widespread alopecia areata (25 extensive alopecia areata, 5 alopecia areata) for a mean period of 4.2 years were included in the study. All patients above 12 years were administered 5 mg dexamethasone oral pulse on two consecutive days every week. Three children (< 12 years) received 2.5 mg to 3.5 mg dexamethasone oral biweekly pulse. Patients who had received treatment for a minimum period of 12 weeks were evaluated for terminal hair growth. Complete to excellent (75-95%) hair growth was observed in 16 (63.3%) patients. Growth was good (50-74%) in 2 cases and poor (< 50%) in 3 (10%) cases. Six (20%) patients has no growth of terminal hair. Complete to excellent growth of hair was obtained after a mean period of 5.35 months (range 3-10 months). Relapse occurred in one case each after three and six months but hair regrew with re-treatment. Side effects of corticosteriods were frequent, seen in 8 (26.6%) patients, but were mild. In only one case, treatment had to be discontinued. We propose that twice weekly 5 mg dexamethasone oral pulse for six months may be considered as one of the modalities in the treatment of extensive long standing alopecia areata.     

方正酸二丁酯外用治疗斑秃疗效观察

目的　观察方正酸二丁酯 (squaricaciddibutylester,SADBE)外用治疗斑秃的临床疗效。 方法　 2 %SADBE丙酮溶液作斑贴试验 ,阳性者给予 0 .0 0 0 0 1%～ 1.0 %的SADBE溶液外用 ,每周 1次。结果　治疗组 16例中 13例 (81.2 5% )长出新发 ,其中 11例 (68.75% )毛发完全再生 ,3例 (18.75% )无新发出现。结论　SADBE局部外用是治疗斑秃的有效方法之一。     

复方甘草酸苷联合光化学疗法治疗斑秃30例疗效观察

目的探讨复方甘草酸苷联合光化学疗法(PUVA)治疗斑秃的疗效和安全性。方法 90例斑秃患者随机分为3组,治疗组30例,外涂0.1%8-甲氧补骨脂溶液30min后,用UVA照射患处,2次/周,同时每天服用复方甘草酸苷75mg,3次/d;对照Ⅰ组30例,每天服用复方甘草酸苷;对照Ⅱ组30例,外涂0.1%8-甲氧补骨脂溶液30min后,用UVA照射患处,2次/周。3组疗程均为8周,观察疗效及不良反应。结果治疗组、对照Ⅰ组和对照Ⅱ组有效率分别为93.33%,70.00%和73.33%,治疗组与两对照组比较差异均有统计学意义(P均<0.05)。结论复方甘草酸苷联合光化学疗法治疗斑秃具有良好的疗效和较高的安全性。     

PUVA treatment of alopecia areata

Twenty-three patients with alopecia areata were treated with photochemotherapy combining oral or topical methoxsalen and UV-A irradiation of the scalp or of the whole body. Eleven of 17 patients with multiple plaques of alopecia areata, alopecia totalis, and alopecia universalis, who were treated with oral methoxsalen and total body irradiation, had complete or more than 90% hair regrowth. Three patients had a relapse. The mean energy required was 505 joules/sq cm. In six cases, topical applications of methoxsalen or oral methoxsalen combined with local irradiation of the scalp were treatment failures. In the patients responding to treatment, the result did not seem to depend on the age of onset or the extent or duration of disease. However, patients with long-lasting alopecia had a higher risk of recurrence notwithstanding a good initial regrowth of hair. Few side effects of psoralens and UV-A (PUVA) treatment were noted. The mean follow-up period was 18.6 months after the completion of treatment. We discuss the possible mechanisms of action of PUVA in the treatment of alopecia areata.     

Different freezing time of superficial liquid nitrogen cryotherapy in treatment of recalcitrant alopecia areata: Randomized clinical trial

Recalcitrant alopecia areata is not uncommon in clinical practice and some patients experienced either treatment failure or recurrence with most of the conventional therapies. Several studies have evaluated the efficacy of cryotherapy in the treatment of alopecia areata with controversial results. This study aimed to optimize the ideal timing of liquid nitrogen cryospraying to achieve the most favorable results. A total of 75 patients with recalcitrant alopecia areata were treated with superficial cryotherapy, two freeze‐thaw cycles, each consisted of 3 to 5, 8 to 10, and 13 to 15 seconds in group A, B, and C, respectively. Good to moderate improvement was achieved in 65.2%, 76%, and 76.2% in groups A, B, and C, respectively, with no statistically significant difference. However, the mean percentage of improvement was significantly higher in group B and C compared to group A (P‐value < .05 for each). Superficial liquid nitrogen cryotherapy is an effective therapeutic modality for recalcitrant alopecia areata. Moreover, using 8 to 10 seconds dual freeze‐thaw cycles is the optimum timing.     

Chemical peeling with phenol : For the treatment of stable vitiligo and alopecia areata

Chemical peeling with 88% phenol was carried out on 142 sites of stable vitiligo (hairy-126, non hairy-16) and on 69 sites of alopecia areata (AA). After cleansing and defatting, phenol was applied on affected areas till a uniform frost appeared. On healing, all the lesions of vitiligo showed perifollicular pigmentation in hairy areas and perilesional repigmentation in non hairy areas. These were further treated with PUVA/PUVASOL. After the healing, 82.5% of hairy sites and 81.3% of non hairy sites showed repigmentation. In cases of AA, patients developed vellus hair. In AA, 72.5% had good regrowth and 27.5% had poor response. Side effects seen were hypopigmentation (58 AA), hyperpigmentation (11 AA), persistent erythema (42 vitiligo, 28 AA), demarcation lines (4 AA), secondary bacterial infection (2 vitiligo, 5 AA) and superficial scarring (2 vitiligo, 7 AA). The wounding action of phenol is useful to repigment the vitiligo patches and for induction of regrwoth of hair in alopecia areata.     

Is there a role for sulfasalazine in the treatment of alopecia areata?

Promising results have been published in the past with the use of sulfasalazine in alopecia areata. We also observed maintenance of hair growth in refractory alopecia areata patients who were treated with sulfasalazine in combination with oral corticosteroids for 2 to 6 months and sulfasalazine alone for 4 to 12 months while steroids were being tapered. We believe that, because of the small series reported herein, additional larger prospective studies should be conducted to validate these results.     

Incidence of alopecia areata in lupus erythematosus.

BACKGROUND--A small percentage of patients with alopecia areata have connective diseases such as systemic lupus erythematosus, discoid lupus erythematosus, rheumatoid arthritis, and scleroderma. Lupus erythematosus is associated with a number of different types of alopecia, but the incidence of alopecia areata in lupus erythematosus has not been examined. OBSERVATIONS--Of our cohort of 39 patients with lupus erythematosus, alopecia areata developed in 10% (four patients), in contrast to 0.42% of general dermatologic patients. Biopsy specimens of alopecia areata lesions in each of our patients showed continuous granular deposition of IgG at the dermoepidermal junction, a finding usually found in only a minority of alopecia areata cases. Intralesional injections of corticosteroids were effective treatment. CONCLUSIONS--The incidence of alopecia areata in patients with lupus erythematosus is increased. Recognition of this form of alopecia allows for specific therapy with intralesional corticosteroids.