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.