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Hair Loss News Archives
February 2003
New Treatments in Alopecia Areata
Medscape Dermatology
Question
Are there any new therapies for the treatment of alopecia areata?
from Amy J. McMichael, MD
Alopecia areata is a nonscarring hair-loss condition that often has a patchy distribution and can be quite unpredictable.
Alopecia areata is believed to be an autoimmune disease[1] involving T lymphocytic infiltrate around the hair follicle.
Therapeutic options depend on several factors, including amount of hair-bearing skin involved and the age of the patient.[2] Intralesional steroids have been a mainstay of treatment.
Topical steroids, anthralin, and minoxidil are additional therapeutic modalities that have been used with mixed success over the last several years.
Topical immunotherapy is relatively new in the treatment of alopecia areata and has been showing promising results in many patients.
The contact sensitizer squaric acid dibutylester (SADBE) is an ideal immunogen in that it is a strong topical sensitizer, is not found in the natural environment, does not cross-react with other chemicals, and is not mutagenic by the Ames test.
After sensitization by application to a small patch of skin, SADBE is applied to the areas of alopecia on an individualized schedule; concentration is based on tolerance and hair regrowth response. People who are "responders" may note initial hair regrowth after approximately 12 weeks of treatment.
Topical tacrolimus is an immunomodulatory macrolide that has been used with great success in the treatment of atopic dermatitis and has recently been shown to have beneficial effects on alopecia areata-like hair loss in a mouse model.[3]
The reports, to date, on efficacy in humans have been less satisfying; in fact, a presentation by Dr. Vera Price at the Alopecia Areata Research Symposium noted that topical tacrolimus did not work for alopecia areata.
Another immune-modifying topical agent, imiquimod, which is approved by the US Food and Drug Administration for the treatment of genital warts, has also been used in the treatment of alopecia areata but, again, with mixed results.
References
Madani S, Shapiro J. Alopecia areata update. J Am Acad Dermatol. 2000;42:549-566. Abstract
Papadopoulos AJ, Schwartz RA, Janniger CK. Alopecia areata. Pathogenesis, diagnosis, and therapy. Am J Clin Dermatol. 2000;1:101-105. Abstract