Immune Suppression Drug Helps Patchy Baldness

NEW YORK (Reuters Health) -

A long-used anti-inflammatory prescription drug can help some people with patchy baldness regrow their hair, according to a new report.

The drug, sulfasalazine, is often prescribed for psoriasis and rheumatoid arthritis. Researchers led by Dr. Charles N. Ellis of the University of Michigan in Ann Arbor have shown that sulfasalazine can also help people with alopecia areata, a condition characterized by recurrent episodes of patchy hair loss.

"When it works, it works great," said study author Dr. John J. Voorhees of the University of Michigan. However, "in at least one half of people it doesn't work at all," he added.

The study, published in a recent issue of the Journal of the American Academy of Dermatology, describes the experience of four patients using sulfasalazine (Azulfidine). The investigators also examined medical records of 249 alopecia areata patients.

Of the 30 patients given sulfasalazine, the researchers noted that 7 experienced a complete regrowth of their hair, indicating the drug offers a 23% chance of a total reversal of the condition. Three other patients reported a reappearance of some of their hair, but not to a level deemed "cosmetically acceptable," the authors note.

Of the four patients presented as clinical studies, three experienced a regrowth of hair while on the medication.

However, the fourth patient, a fraternal twin of one of the patients in whom sulfasalazine worked, saw no improvement with the medication.

Alopecia areata is a form of baldness that affects around 2% of the population during their lifetime. It occurs in both men and women.

Alopecia areata is characterized by sudden, recurrent loss of hair in round spots from any part of the body that has hair, including the scalp, eyebrows, and eyelashes.

People with this form of baldness may simply develop a few easily concealed hairless patches, while some may lose every hair on their bodies.

"It's a very difficult thing to have," Voorhees told Reuters Health.

Alopecia areata occurs, Voorhees explained, when the body's immune system cells decide, for unknown reasons, to attack hair follicles. This, in turn, causes inflammation around the follicles, which prevents hair from growing. It is believed sulfasalazine helps to treat alopecia areata by inhibiting inflammation.

Previous treatments for this form of baldness are not generally effective, Voorhees said. The most effective treatment has involved injecting steroids into hairless patches, which is too toxic to use on large areas of the body, he added.

In some cases, hair lost during an episode of alopecia areata can grow back without any treatment.

Sulfasalazine is a drug that has been available for many years. It is used as first-line treatment for rheumatoid arthritis in Europe, Voorhees said, and is also commonly prescribed in the US.

Patients generally tolerate the treatment, Voorhees said, with some reporting minor gastrointestinal problems or headache. Serious side effects, such as liver toxicity, are rare.

SOURCE: Journal of the American Academy of Dermatology 2002;46:541-544.