Ann Dermatol.  2017 Dec;29(6):755-760. 10.5021/ad.2017.29.6.755.

Simvastatin/Ezetimibe Therapy for Recalcitrant Alopecia Areata: An Open Prospective Study of 14 Patients

• Choi JW
• Suh DW
• Lew BL
• Sim WY

• KMID: 2395184
• DOI: http://doi.org/10.5021/ad.2017.29.6.755

Abstract

BACKGROUND
Simvastatin belongs to the statin family, whose members have immunomodulatory activities. Ezetimibe have synergetic effects when co-administered with simvastatin. In several case reports, alopecia totalis and alopecia universalis were successfully treated with simvastatin/ezetimibe, suggesting that this combination could be a new efficient therapy for recalcitrant alopecia areata (AA).
OBJECTIVE
To verify the efficacy of the simvastatin/ezetimibe combination therapy for recalcitrant AA and investigate the relationship between various treatment responses and prognostic factors.
METHODS
This prospective open study was performed in patients with recalcitrant AA with the bald surface exceeding 75%. All patients took simvastatin (40 mg) and ezetimibe (10 mg) daily. The extent of hair regrowth expressed as percentage of the bald area was used to evaluate the effectiveness of the therapy.
RESULTS
Of 14 enrolled patients, 4 patients (28.6%) were judged as responders showing regrowth of 30% to 80% after 3 months of treatment. The mean age of onset in non-responders was significantly lower than in responders. The total score of prognostic factors, calculated as a sum of factors related to poor prognosis, was much lower in responders than in non-responders.
CONCLUSION
The remission rate in this study was unsatisfactory. However, since the recruited patients had not responded to any other treatments for AA, simvastatin/ezetimibe can still be considered as an alternative treatment for recalcitrant AA. The total scores of the prognostic factors were statistically different between responders and non-responders. These results can be used to predict the outcome of treatment with simvastatin/ezetimibe and anticipate prognosis.

Keyword

Alopecia areata; Ezetimibe; Prognostic factor; Simvastatin

MeSH Terms

Age of Onset
Alopecia Areata*
Alopecia*
Ezetimibe
Hair
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Prognosis
Prospective Studies*
Simvastatin
Ezetimibe
Simvastatin

Figure

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  Fig. 1 Alopecia areata. Patient no. 10 is a responder with preservation of the regrown hair. (A) Before treatment, (B) 3 months after treatment, (C) 6 months after treatment.

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  Fig. 2 The differences in mean disease duration (A) and mean age of onset (B). The Mann-Whitney U test was used to compare the groups. *Stastically significant, p<0.05.

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  Fig. 3 The average total scores of prognostic factors. The Mann-Whitney U test was used to compare the groups. *Stastically significant, p<0.05.

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