Cyclosporine Combination Therapy in Alopecia Areata

Park, Hyun Ho; Sim, Woo Young

Abstract

BACKGROUND: Alopecia areata is a common dermatologic disorder and the course is so variable that some patients undergo spontaneous remission and others undergo total hair loss. There is no clearly superior therapy in the treatment of alopecia areata. The theory of autoimmune pathogenesis of alopecia areata suggests a potential therapeutic effect of cyclosporine.
OBJECTIVE
We evaluated the therapeutic effect of oral cyclosporine combined with other modalities in severe and refractory alopecia areata. METHOD: 28 patients(M:16, F:12) with severe or refractory alopecia areata were treated with oral cyclosporine 3-4 mg/kg/day, oral prednisolone 5 mg/day, topical steroid and minoxidil for at least 3 months. Subjects were composed of 12 multifocal alopecia areata patients, 10 alopecia totalis patients, and 6 alopecia universalis patients. Blood pressure, CBC/DC, liver function test, BUN/Cr, Na/K/Cl, lipid series, and urinalysis were checked to avoid any side effects.
RESULTS
1. Of the 28 patients, 20 patients(71%) showed new hair growth, 5 patients(18%) did not respond to therapy and 3 patients(11%) were not available for follow up exams. 2. Mean time until new hair growth was 2.5 months. 3. Side effects occurred in 13 patients(47%), and they were as follows: 4 patients with hypertrichosis, 4 patients with gastrointestinal disturbances, 2 patients with abnormal urinalysis, and 3 patients with lipid series abnormality. 4. Three patients discontinued therapy due to side effects of 2 beause hypertrichosis and 1 because of abnormal urinalysis.
CONCLUSION
Cyclosporine combination therapy is recommended in severe and refractory alopecia areata. Side effects were observed in 13 patients, but most of them were mild and transient. Severe side effects can be prevented by careful monitoring.