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.     

Alopecia areata treatment with a phototoxic dose of UVA and topical 8-methoxypsoralen

Twenty-five patients with alopecia totalis (AT) or alopecia universalis and 124 patients with alopecia areata (AA) were treated with photochemotherapy, combining topical 8-methoxypsoralen (8-MOP) with UV irradiation of the scalp at a phototoxic dose. The mean energy required was 15 J/cm2 for AA and 42 J/cm2 for AT. Ninety-four patients had multiple bald patches and 12 with AT had complete or > 50% hair regrowth. Positive treatment results did not seem to depend on the age of onset or the duration of the disease. Few side-effects of topical psoralens plus UVA (PUVA) treatment were noted, except a for few days of slight erythema caused by the high dose of UV.     

Topical minoxidil for hair regrowth

Minoxidil, a potent peripheral vasodilator used orally for refractory hypertension, has produced hypertrichosis. To determine the efficacy and safety of 1% or 5% topical minoxidil for the stimulation of scalp hair regrowth, we studied fifteen normotensive patients, five with androgenic alopecia and ten with alopecia areata diagnosed clinically and by biopsy, for 12 months. Three of five patients with androgenic alopecia using 5% minoxidil for 12 months noted hair regrowth, ranging from minimally observable hair to an appreciable restoration of larger, pigmented, terminal hair in one patient. Among the patients with androgenic alopecia, regrowth response corresponded to the serum minoxidil blood levels. None of the patients with alopecia areata receiving either 1% or 5% minoxidil noted hair regrowth despite comparable minoxidil blood levels. Improved local absorption of topical minoxidil solution may promote hair regrowth in androgenic alopecia.     

The PUVA-turban as a new option of applying a dilute psoralen solution selectively to the scalp of patients with alopecia areata

BACKGROUND: Alopecia areata is a burden for many patients and often resistant, even to extensive therapy. Orally administered PUVA therapy has been shown among numerous systemic and topical treatment modalities to be a therapeutic alternative. However, the clinical use of oral PUVA is often limited by systemic side effects. Bath-PUVA therapy offers an alternative solution because of the negligible systemic absorption of psoralen with this technique. Through use of a "PUVA-turban" it is now possible to administer a dilute bathwater solution containing 8-methoxypsoralen (8-MOP) to the scalp. OBJECTIVE: The purpose of this study was to determine whether PUVA turban therapy is effective in treating alopecia areata in different clinical stages. METHODS: We treated 9 patients with severe, rapidly progressing, treatment-resistant alopecia areata with PUVA-turban treatment as a modification of bath-PUVA therapy. At each treatment session a cotton towel was soaked with a 0.0001% 8-MOP solution (1 mg/L) at 37 degrees C, wrung gently to remove excess water, and wrapped around the patient's head in a turban fashion for 20 minutes. This was directly followed by UVA radiation. Treatment sessions were initially performed 3 to 4 times per week. RESULTS: The cumulative UVA doses given over treatment periods of up to 24 weeks were 60.9 to 178.2 J/cm(2), with single doses ranging from 0.3 to 8.0 J/cm(2). After up to 10 weeks of treatment, hair regrowth could be noticed in 6 of 9 patients. Two patients did not respond to the treatment, and one patient showed only vellus hair regrowth. CONCLUSION: PUVA-turban therapy can be considered a useful method of administering a dilute psoralen solution selectively to the scalp of patients. It has been shown to be a well-tolerated and, in some patients, efficient therapeutic alternative in the treatment of alopecia areata.     

Diphencyprone in the treatment of long-standing alopecia areata

Thirty-six patients with alopecia areata of 1-54 years duration entered a study of treatment with the contact allergen diphencyprone for 8 months. Following sensitization the diphencyprone was applied to one half of the scalp at weekly intervals, the other half acting as a control. Once hair growth was established on one side, the other side was treated. Seven patients did not continue treatment and one patient showed spontaneous regrowth. Of the remaining 28 patients who persisted with treatments, fourteen (50%) regrew hair on the treated side; eight (29%) had a cosmetically acceptable result with the regrowth of terminal hair over the whole scalp. No statistically significant differences were found in age or duration of alopecia between those who regrew and those who did not. We have found diphencyprone to be an effective stimulator of hair growth in patients with severe and long-standing alopecia areata.     

Topical minoxidil dose-response effect in alopecia areata

Topical 5% minoxidil solution was used to treat 47 patients with severe alopecia areata. Forty patients (85%) had terminal hair regrowth after 48 to 60 weeks of treatment. In the majority of patients, hair regrowth was not cosmetically acceptable. Data were compared with those from a previous study with topical 1% minoxidil solution. Both the percentage of responders and the quality of their hair regrowth were significantly greater with 5% than with 1% topical minoxidil solution. One patient developed an allergic contact dermatitis to minoxidil, but no systemic side effects were detected. The results strongly suggest a dose-response effect for topical minoxidil treatment of alopecia areata and the importance of exploring modifications in dosing and delivery systems to enhance therapeutic efficacy.     

Clobetasol propionate 0.05% under occlusion in the treatment of alopecia totalis/universalis

BACKGROUND: Efficacy of topical steroids in alopecia areata is still discussed. OBJECTIVE: The purpose of this study was to evaluate the efficacy of clobetasol propionate 0.05% ointment under occlusion in 28 patients with alopecia areata totalis (AT) or AT/alopecia universalis. METHODS: A total of 28 patients were instructed to apply 2.5 g of clobetasol propionate to the right side of the scalp every night under occlusion with a plastic film. Treatment was performed 6 days a week for 6 months. When regrowth of terminal hair occurred, treatment was extended over the entire scalp. All patients were followed up for another 6 months. RESULTS: Of the 28 patients included in the study, 8 were treated successfully (28.5%). Regrowth of terminal hair began on the treated side 6 to 14 weeks after the start of treatment. Of these 8 patients, 3 had a relapse and were not able to maintain hair regrowth. CONCLUSION: Our study shows that clobetasol propionate 0.05% under occlusion is effective in inducing hair regrowth in patients with AT or AT/alopecia universalis. Occurrence of hair regrowth only on the treated half of the scalp clearly shows that efficacy of treatment is a result of a local and not systemic effect of the drug. Although only 17.8% of patients had long-term benefit by treatment, our results were obtained in a population of patients with severe and refractory forms of the disease.     

Response to minoxidil in severe alopecia areata correlates with T lymphocyte stimulation

Mitogen-induced T cell blastogenesis was determined in 47 patients with severe alopecia areata, before and after treatment with topical 5% minoxidil, and compared with control values. The group of 36 responders, who demonstrated terminal hair regrowth, showed significantly increased lymphocyte stimulation with concanavalin A and PHA before treatment, which decreased towards control values following hair regrowth. Lymphocytes from non-responders showed no significant differences from controls either before or after treatment. The results suggest that enhanced T cell blastogenesis may predict the response of severe alopecia areata to topical 5% minoxidil therapy.     

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。     

Seventeen cases of alopecia areata: combination of SADBE topical immunotherapy with other therapies

Topical immunotherapy is effective for severe alopecia areata. However, there are patients with alopecia areata refractory to topical immunotherapy alone. We tried SADBE (squaric acid dibutylester) topical immunotherapy combined with topical dry ice cryotherapy, carpronium chloride (a parasympathetic nerve stimulant) and/or oral cepharanthin (a biscoclaur alkaloid) in alopecia areata refractory to topical SADBE. Seventeen patients with alopecia areata (3 multiple, 3 ophiasis, 5 totalis and 6 universalis) were treated with SADBE in our department in 1999 to 2001. In 3 cases (2 multiple and 1 universalis) out of the 17 cases, cosmetically acceptable regrowth of hair was observed in several months with topical SADBE alone. In the other 14 cases, the SADBE therapy alone for several months (mean: 6.9 months) resulted in no or poor regrowth of hair. However, with subsequent combination therapy of topical SADBE for several months (mean: 7.6 months), satisfactory regrowth of hair was observed in 6 of the 14 cases. Our cases indicate that combination therapy of topical SADBE with other therapies can be a choice for alopecia areata which is refractory to topical SADBE therapy alone.     

Systemic steroids with or without 2% topical minoxidil in the treatment of alopecia areata.

BACKGROUND AND DESIGN--Thirty-two patients with mild to extensive alopecia areata, including 16 patients with alopecia totalis or universalis, entered a randomized, controlled trial of a 6-week taper of prednisone followed by either 2% topical minoxidil or vehicle applied three times daily for an additional 14 weeks. The results of this study were compared with an open trial of 48 patients with alopecia areata treated with a similar taper of prednisone with concomitant 2% topical minoxidil applied twice daily. Only terminal hair growth was considered and was quantitated as 1% to 24%, 25% to 49%, 50% to 74%, and 75% to 100%: only those with more than 25% terminal hair regrowth were considered to have had an objective response. RESULTS--At the end of 6 weeks of prednisone, 47% (15/32) of patients had more than 25% regrowth, including nine of 20 patients who had had at least 75% hair loss at baseline. Side effects of prednisone were primarily weight gain and mood changes/emotional lability. At 3 months, six of seven minoxidil-treated patients vs one of six vehicle-treated patients who had an objective response to prednisone maintained or augmented this hair growth: at the 20-week visit, these numbers were three of seven and zero of four patients, respectively. In the open trial, objective hair growth with prednisone was 30%, related to the extent of hair loss at baseline, and this growth persisted in more than 50% of patients at 6 months with the use of 2% topical minoxidil. CONCLUSIONS--A 6-week taper of prednisone offers potential for more than 25% regrowth in 30% to 47% of patients with alopecia areata with predictable and transient side effects. Two percent topical minoxidil three times daily appears to help limit poststeroid hair loss.     

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.     

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.     

PUVA treatment of alopecia areata partialis, totalis and universalis: audit of 10 years' experience at St John's Institute of Dermatology

Our 10-year experience with PUVA treatment for alopecia areata. partialis, totalis and universalis was retrospectively reviewed using charts and follow-up questionnaires for 70 patients at St John's Institute of Dermatology. In all cases, several previous therapies were judged to be unsatisfactory prior to starting PUVA, and many cases were already deemed clinically refractory prior to referral for PUVA. If cases of vellus hair growth are excluded, and those who lost their PUVA-induced regrowth rapidly on follow-up, the effective success rate was at best 6·3% for alopecia areata partialis, 12·5% for alopecia areata totalis and 13·3% for alopecia areata universalis. We affirm that PUVA is generally not an effective treatment for alopecia areata.     

Treatment of persistent alopecia areata with sulfasalazine

Background  Alopecia areata is an autoimmune disease with no definitive treatment, and some cases persist despite standard therapies. Sulfasalazine has been reported to show success in the treatment of persistent cases of alopecia areata.
Objective  To assess the efficacy of sulfasalazine in cases of recalcitrant alopecia areata that do not respond to topical and intralesional corticosteroids, 5% minoxidil, or psoralen plus ultraviolet-A (PUVA) therapy.
Methods  Thirty-nine patients with persistent alopecia areata received 3 g of oral sulfasalazine for 6 months, and terminal hair regrowth was quantified as no response, moderate response, or good response.
Results  A good response occurred in 10 of the 39 patients (25.6%), a moderate response in 12 (30.7%), and a poor or no response in 17 (43.5%).
Conclusion  Sulfasalazine can be used as an alternative drug in patients with persistent alopecia areata.     

Topical 5-fluorouracil is ineffective in the treatment of extensive alopecia areata

We report the results of a pilot study of topical 5% 5-fluorouracil (FU) cream for the treatment of alopecia areata, an immunologically modulated disorder of hair growth. Patients with extensive (>50% scalp surface area involvement) alopecia areata that was refractory to previous treatments applied 5-FU to one side of their scalp twice daily for 3 to 6 months. In all, 9 patients enrolled, and 8 completed the study. No patient experienced measurable hair growth on the treated side. Only mild irritation was observed in a subset of patients with application of 5-FU to the nonphotodamaged scalp skin. Based on these results, we cannot recommend the use of topical 5-FU for treatment of alopecia areata without further evidence of therapeutic benefit.     

Alopecia areata in children:, response to treatment with diphencyprone

Twelve children with extensive alopecia areata or alopecia totalis were treated with the contact allergen diphencyprone. The duration of treatment ranged from 5 months to 1 year. Eight of the 12 (67%) regrew scalp hair and in four (33%) there was a complete regrowth. Six months after treatment was discontinued three of the four children with complete regrowth maintained their hair, one had lost all the regrowth and a further child with patchy regrowth at the end of treatment subsequently regrew hair completely while off therapy.     

Pronounced perifollicular lymphocytic infiltrates in alopecia areata are associated with poor treatment response to diphencyprone

Some authors have reported that severe destruction of follicular structures and even scarring patterns occur in those patients with alopecia areata (AA) who fail to respond to topical immunotherapy with contact sensitizers, such as diphencyprone (DCP). Other studies, however, gave contradictory results. Therefore, we re-examined histopathological changes in scalp samples obtained from 85 patients with severe alopecia areata before initiation of DCP treatment (40 responders and 45 non-responders in terms of hair regrowth after DCP treatment). The following parameters were evaluated: i) perifollicular lymphocytic infiltration; ii) perifollicular fibrosis, and iii) miniaturized hair follicles. No difference between responders and non-responders could be observed in the degree of miniaturization of hair follicles and proliferation of perifollicular fibrous tissue. In neither group was there any evidence of scarring or severe follicular destruction. 18 non-responders but only 6 responders showed a very dense perifollicular lymphocytic infiltration. In contrast, a particularly scarce infiltrate was seen in 9 non-responders and in 19 responders. We conclude that non-responders to topical sensitizers tend to have rather pronounced inflammatory reactions with dense perifollicular lymphocytic infiltrates.     

PUVA treatment of alopecia areata totalis and universalis: a retrospective study

The results of PUVA treatment of alopecia areata (AA) totalis and universalis were reviewed in 26 adult patients. Eight of 15 patients with AA totalis and six of 11 patients with AA universalis achieved a complete response (>90% hair regrowth). Patients with AA totalis had a greater incidence of treatment failure (<25% hair regrowth) than those with AA universalis. Patients with a family history of AA were significantly less likely to have a positive response to PUVA than those with no family history. Sex, age at diagnosis and treatment, interval between diagnosis and treatment, and background of atopy were not significant determinants of outcome. Although unable to show significance for clinical response to treatment, this study demonstrates complete hair regrowth in patients with both AA totalis (53%) and universalis (55%) while reporting a low relapse rate among these patients (21%) within a long period of follow up (mean 5.2 years).     

Topical diphencyprone for alopecia areata: evaluation of 48 cases after 30 months' follow-up

Summary Forty-eight patients (23 male, 25 female) with severe alopecia areata were sensitized and treated with topical diphencyprone. Thirty-eight per cent of the subjects had good regrowth of hair at a mean follow-up period of 30–8 months. The presence of nail changes, a personal history of atopy and a long duration of alopecia had an adverse prognostic effect.