Therapeutic Effect of Topical Anthralin for Treatment-Resistant Extensive Alopecia Areata

Hong, Won Kyu; Shin, Jeong Hyun; Choi, Gwang Seong

Abstract

BACKGROUND: Extensive alopecia areata (EAA) is resistant to multiple individual treatment modalities and has poor prognosis for cosmetically adequate regrowth. Anthralin is a widely used topical anti-psoriatic drug that may have an immunomodulating effect on AA as is does in psoriasis. But, there has only been small number of clinical trials of anthralin in the treatment of AA.
OBJECTIVE
The purposes of the study were to evaluate the efficacy, prognostic factor, side effects and recurrence rate of topical anthralin therapy in treatment-resistant EAA.
METHODS
A total of 16 cases of EAA (>50% scalp hair loss) who had failed in previous treatments were subjected in this study. Anthralin in 0.5% concentrations was applied to alopectic lesions for 1 hour daily over 4 weeks, gradually increasing anthralin concentration until low-grade erythema and pruritus develops. Treatment was withdrawn after complete response or if there were no signs of improvement at 6 months. Responders were followed up for 6 months after discontinuation of therapy.
RESULTS
The overall response rate was 62.5%, complete response (>90% regrowth or cosmetically acceptable appearance) was obtained in 25% of cases and, good response (50~99% regrowth) in 39.5% of cases. In this study, among the investigated prognostic factors, there were no statistically significant factors (p<0.05, Fisher exact test). The most frequent side effects were therapeutically induced mild pruritus (93.8%), erythema (93.8%) and scale (56.3%). Other side-effects were transient folliculitis (31.3%) and regional lymph adenopathy (12.5%). Relapse was observed in 60% of responders after 6 month of follow up.
CONCLUSION
Topical anthralin for treatment-resistant EAA is an effective therapy with tolerable side effects. Therefore, we propose the topical anthralin as a reasonable therapeutic option for treatment-resistant EAA.