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February 27, 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
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Madani S, Shapiro J. Alopecia
areata update. J Am Acad Dermatol. 2000;42:549-566.
Abstract
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Papadopoulos AJ, Schwartz RA,
Janniger CK. Alopecia areata. Pathogenesis, diagnosis, and therapy. Am J Clin
Dermatol. 2000;1:101-105.
Abstract
 
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