Journal Information
Vol. 100. Issue 4.
Pages 266-276 (May 2009)
Share
Share
Download PDF
More article options
Vol. 100. Issue 4.
Pages 266-276 (May 2009)
Advances in dermatology
Full text access
Update on the Treatment of Alopecia Areata
Actualización Terapéutica en Alopecia Areata
Visits
11575
M. Galán-Gutiérrez
Corresponding author
Minos72@hotmail.com

Correspondence: Servicio de Dermatología. Hospital Universitario Reina Sofía, Av. Menéndez Pidal, s/n, 14004 Córdoba, Spain.
, A. Rodríguez-Bujaldón, J.C. Moreno-Giménez
Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Reina Sofía, Córdoba, Spain
This item has received
Article information
Abstract

Alopecia areata is nonscarring telogenic alopecia of autoimmune etiology. It is estimated to be thepresenting complaint in 2% of dermatologic consultations, and can appear at any age although it is more common in young patients.Treatment depends on several factors, such as extent of the disease and age, and maybe local or systemic. Local treatments aim to achieve hair regrowth, but do not alter the underlying condition, whereas systemic treatments can modify the course of the disease. In neither case does treatment provide a cure. In this article, we review most of the therapeutic options described in the literature for alopecia areata.

Key words:
alopecia areata
diphenylcyclopropenone
corticosteroids
cyclosporine
Resumen

La alopecia areata es una alopecia no cicatricial telogénica de base autoinmune. Se estima que origina un 2% de las consultas dermatológicas y puede aparecer a cualquier edad, aunque es más frecuente en pacientes jóvenes. Su tratamiento va a depender de varios factores, fundamentalmente de la extensión de la enfermedad, de la edad del paciente, así como de medidas locales y sistémicas. Mientras que los tratamientos locales tienen como objetivo conseguir el recrecimiento piloso, sin influir en la evolución de la enfermedad, los tratamientos sistémicos pueden interferir en la evolución de la misma, siendo ambos medidas paliativas. En este trabajo revisamos la mayoría de las opciones terapéuticas descritas en la literatura para la alopecia areata.

Palabras clave:
alopecia areata
difenciprona
corticoides
ciclosporina
Full text is only aviable in PDF
References
[1.]
M.J. García Hernández, F. Camacho Martínez.
Epidemiología clínica de la alopecia areata.
Actas Dermosifiliogr, 93 (2002), pp. 223-228
[2.]
S.P. MacDonald Hull, M.L. Wood, P.E. Hutchinson, M. Sladden, A.G. Messenger.
British Association of Dermatologists. Guidelines for the management of alopecia areata.
Br J Dermatol, 149 (2003), pp. 692-699
[3.]
V.C. Fiedler-Weiss, C.M. Buys.
Evaluation of anthralin in the treatment of alopecia areata.
Arch Dermatol, 123 (1987), pp. 1491-1493
[4.]
D.A. Nelson, R.L. Spielvogel.
Anthralin therapy for alopecia areata.
Int J Dermatol, 24 (1985), pp. 606-607
[5.]
C. Schmoeckel, I. Weissmann, G. Plewig, O. Braun-Falco.
Treatment of alopecia areata by anthralin-induced dermatitis.
Arch Dermatol, 115 (1979), pp. 1254-1255
[6.]
V.C. Fiedler, S. Alaiti.
Treatment of alopecia areata.
Dermatol Clin, 14 (1996), pp. 733-738
[7.]
A. Gilhar, T. Pillar, A. Etzioni.
Topical cyclosporin A in alopecia areata.
Acta Derm Venereol, 69 (1989), pp. 252-253
[8.]
G. Mauduit, P. Lenvers, H. Barthelemy, J. Thivolet.
Treatment of severe alopecia areata with topical applications of cyclosporin A.
Ann Dermatol Venereol, 114 (1987), pp. 507-510
[9.]
Y. DeProst, D. Teillac, F. Paquez, C. Carrugi, H. Bachelez, R. Touraine.
Treatment of severe alopecia areata by topical applications of cyclosporine: comparative trial versus placebo in 43 patients.
Transplant Proc, 20 (1988), pp. 112-113
[10.]
D.D. Verma, A. Fahr.
Synergistic penetration enhancement effect of ethanol and phospholipids on the topical delivery of cyclosporin A.
J Control Release, 97 (2004), pp. 55-66
[11.]
S. Charuwichitratana, P. Wattanakrai, S. Tanrattanakorn.
Randomized double-blind placebo-controlled trial in the treatment of alopecia areata with 0.25% desoximetasone cream.
Arch Dermatol, 136 (2000), pp. 1276-1277
[12.]
G. Mancuso, A. Balducci, C. Casadio, P. Farina, M. Staffa, L. Valenti, et al.
Efficacy of betamethasone valerate foam formulation in comparison with betamethasone dipropionate lotion in the treatment of mild-to-moderate alopecia areata: a multicenter, prospective, randomized, controlled, investigatorblinded trial.
Int J Dermatol, 42 (2003), pp. 572-575
[13.]
A. Tosti, B.M. Piraccini, M. Pazzaglia, C. Vicenzi.
Clobetasol propionate 0,05% under occlusion in the treatment of alopecia totalis/universalis.
J Am Acad Dermatol, 49 (2003), pp. 96-98
[14.]
A. Tosti, M. Iorizzo, G.L. Botta, M. Milani.
Efficacy and safety of a new clobetasol propionate 0.05% foam in alopecia areata: a randomized, double-blind placebo-controlled trial.
[15.]
E.P. Kubeyinje.
Intralesional triamcinolone acetonide in alopecia areata amongst 62 Saudi Arabs.
East Afr Med J, 71 (1994), pp. 674-675
[16.]
D. Porter, J.L. Burton.
A comparison of intra-lesional triamcinolone hexacetonide and triamcinolone acetonide in alopecia areata.
Br J Dermatol, 85 (1971), pp. 272-273
[17.]
J. Ferrando, G.A. Moreno-Arias.
Multi-injection plate for intralesional corticosteroid treatment of patchy alopecia areata.
Dermatol Surg, 26 (2000), pp. 690-691
[18.]
M.C. Carnahan, D.A. Goldstein.
Ocular complications of topical, peri-ocular, and systemic corticosteroids.
Curr Opin Opthalmol, 11 (2000), pp. 478-483
[19.]
D.A. Fenton, J.D. Wilkinson.
Topical minoxidil in the treatment of alopecia areata.
Br Med J, 287 (1983), pp. 1015-1017
[20.]
J.P. Vestey, J.A. Savin.
A trial of 1% minoxidil used topically for severe alopecia areata.
Acta Derm Venereol, 66 (1986), pp. 179-180
[21.]
R.E. Ranchoff, W.F. Bergfeld, W.D. Steck.
Extensive alopecia areata. Results of treatment with 3% topical minoxidil.
Cleve Clin J Med, 56 (1989), pp. 149-154
[22.]
V.C. Fiedler-Weiss.
Topical minoxidil solution (1% and 5%) in the treatment of alopecia areata.
J Am Acad Dermatol, 16 (1987), pp. 745-748
[23.]
E.A. Olsen, S.C. Carson, E.A. Turney.
Systemic steroids with or without 2% topical minoxidil in the treatment of alopecia areata.
Arch Dermatol, 128 (1992), pp. 1467-1473
[24.]
R. Happle, H. Klein, E. Macher.
Topical immunotherapy changes in the composition of the peribulbar infiltrate in alopecia areata.
Arch Dermatol Res, 278 (1986), pp. 214-218
[25.]
R. Happle.
Antigenic competition as a therapeutic concept for alopecia areata.
Arch Dermatol Res, 267 (1980), pp. 109-114
[26.]
L. Goldsmith.
Summary of alopecia areata research workshop and future research directions.
J Invest Dermatol, 96 (1991), pp. 98-100
[27.]
C.K. Rokhsar, J.L. Shupack, J.J. Vafai, K. Washenik.
Efficacy of topical sensibilizers in the treatment of alopecia areata.
J Am Acad Dermatol, 39 (1998), pp. 751-761
[28.]
S.P. MacDonald Hull, L. Pepall, W.J. Cunliffe.
Alopecia areata in children: response to treatment with diphencyprone.
Br J Dermatol, 125 (1991), pp. 164-168
[29.]
M.L. Schuttelaar, J.J. Hamstra, E.P. Plinck, J.D. Peereboom-Wynia, V.D. Vuzevski, P.G. Mulder, et al.
Alopecia areata in children: treatment with diphencyprone.
Br J Dermatol, 135 (1996), pp. 581-585
[30.]
A. Tosti, M.S. Guidetti, F. Bardazzi, C. Misciali.
Long-term results of topical immunotherapy in children with alopecia totalis or alopecia universalis.
J Am Acad Dermatol, 35 (1996), pp. 199-201
[31.]
A. Tosti, L. Guerra, F. Bardazzi.
Contact urticaria during topical immunotherapy.
Contact Dermatitis, 21 (1989), pp. 196-197
[32.]
C.A. Henderson, A. Ilchyshyn.
Vitiligo complicating diphencyprone sensitization therapy for alopecia areata.
Br J Dermatol, 133 (1995), pp. 496-497
[33.]
S.P. MacDonald Hull, J.F. Norris, J.A. Cotterill.
Vitiligo following sensitisation with diphencyprone.
Br J Dermatol, 120 (1989), pp. 323
[34.]
M.G. Wilkerson, J. Henkin, J.K. Wilkin.
Squaric acid and esters: analysis for contaminants and stability in solvents.
JAm Acad Dermatol, 13 (1985), pp. 229-234
[35.]
B. García-Bravo, A. Rodríguez-Pichardo, P. Sánchez-Pedreno, F. Camacho.
Nickel sulphate in the treatment of alopecia areata.
Contact Dermatitis, 20 (1989), pp. 228-229
[36.]
E. Suárez Martín.
Treatment of alopecia areata profiting from «natural» allergy to nickel.
Arch Dermatol, 120 (1984), pp. 1138-1139
[37.]
S.C. Behrens-Williams, U. Leiter, R. Schiener, M. Weidmann, R.U. Peter, M. Kerscher.
The PUVA-turban as a new option of applying a dilute psoralen solution selectively to the scalp of patients with alopecia areata.
J Am Acad Dermatol, 44 (2001), pp. 248-252
[38.]
G. Monfrecola, F. D’Anna, M. Delfino.
Topical hematoporphyrin plus UVA for treatment of alopecia areata.
Photodermatology, 4 (1987), pp. 305-306
[39.]
C.R. Taylor, J.L. Hawk.
PUVA treatment of alopecia areata partialis, totalis and universales: audit of 10 years’ experience at St John's Institute of Dermatology.
Br J Dermatol, 133 (1995), pp. 914-918
[40.]
E. Healy, S. Rogers.
PUVA treatment for alopecia areata-does it work? A retrospective review of 102 cases.
Br J Dermatol, 129 (1993), pp. 42-44
[41.]
J.S. Mehta, J. Raman, N. Gupta, D. Thoung.
Cutaneous latanoprost in the treatment of alopecia areata.
[42.]
A. Tosti, M. Pazzaglia, S. Voudouris, G. Tosti.
Hypertrichosis of the eyelashes caused by bimatoprost.
J Am Acad Dermatol, 51 (2004), pp. 149-150
[43.]
E.K. Ross, C. Bolduc, H. Lui, J. Shapiro.
Lack of efficacy of topical latanoprost in the treatment of eyebrow alopecia areata.
J Am Acad Dermatol, 53 (2005), pp. 1095-1096
[44.]
K.J. McElwee, D.H. Rushton, R. Trachy, R.F. Oliver.
Topical FK506: a potent immunotherapy for alopecia areata? Studies using the Dundee experimental bald rat model.
Br J Dermatol, 137 (1997), pp. 491-497
[45.]
P. Freyschmidt-Paul, A. Ziegler, K.J. McElwee, R. Happle, S. Kissling, J.P. Sundberg, et al.
Treatment of alopecia areata in C3H/HeJ mice with the topical immunosuppressant FK506 (Tacrolimus).
Eur J Dermatol, 11 (2001), pp. 405-409
[46.]
V.H. Price, A. Willey, B.K. Chen.
Topical tacrolimus in alopecia areata.
J Am Acad Dermatol, 52 (2005), pp. 138-139
[47.]
R. D’Ovidio, J. Claudatus, T. Di Prima.
Ineffectiveness of imiquimod therapy for alopecia totalis/universalis.
J Eur Acad Dermatol Venereol, 16 (2002), pp. 416-417
[48.]
P.R. Letada, J.D. Sparling, C. Norwood.
Imiquimod in the treatment of alopecia universalis.
Cutis, 79 (2007), pp. 138-140
[49.]
M.M. Clifton, S.M. Johnson, P.K. Roberson, J. Kincannon, T.D. Horn.
Immunotherapy for recalcitrant warts in children using intralesional mumps or Candida antigens.
Pediatr Dermatol, 20 (2003), pp. 268-271
[50.]
E.W. Rosemberg, R.B. Skinner Jr.
Immunotherapy of alopecia areata with intralesional candida antigen.
Pediatr Dermatol, 23 (2006), pp. 299
[51.]
W. Zakaria, T. Passeron, N. Ostovari, J.P. Lacour, J.P. Ortonne.
308-nm excimer laser therapy in alopecia areata.
J Am Acad Dermatol, 51 (2004), pp. 837-838
[52.]
M. Waiz, A.Z. Saleh, R. Hayani, S.O. Jubory.
Use of the pulsed infrared diode laser (904 nm) in the treatment of alopecia areata.
J Cosmet Laser Ther, 8 (2006), pp. 27-30
[53.]
Z. Hajheydari, M. Jamshidi, J. Akbari, R. Mohammadpour.
Combination of topical garlic gel and betamethasone valerate cream in the treatment of localized alopecia areata: a double-blind randomized controlled study.
Indian J Dermatol Venereol Leprol, 73 (2007), pp. 29-32
[54.]
S. Mandani, J. Shapiro.
Alopecia areata update.
J Am Acad Dermatol, 42 (2000), pp. 549-566
[55.]
P. Assouly, P. Reygagne, C. Jouanique, B. Matard, E. Marechal, P. Reynert, et al.
Intravenous pulse methylprednisolone therapy for severe alopecia areata: an open study of 66 patients.
Ann Dermatol Venereol, 130 (2003), pp. 326-330
[56.]
J.L. Burton, S. Shuster.
Large doses of glucocorticoid in the treatment of alopecia areata.
Acta Dermatol Venereol (Stockh), 55 (1975), pp. 493-496
[57.]
V.K. Sharma.
Pulsed administration of corticosteroid in the treatment of alopecia areata.
Int J Dermatol, 35 (1996), pp. 133-136
[58.]
V.K. Sharma, S. Gupta.
Twice weekly 5 mg dexamethasone oral pulse in the treatment of extensive alopecia areata.
J Dermatol, 26 (1999), pp. 562-565
[59.]
A. Agarwal, J. Nath, K.N. Barna.
Twice weekly 5 mg betamethasone oral pulse therapy in the treatment of alopecia areata.
[60.]
J.P. Cerottini, R.G. Panizzon, P.A. de Viragh.
Multifocal alopecia areata during systemic cyclosporine A therapy.
Dermatology, 198 (1999), pp. 415-417
[61.]
A. Dyall-Smith.
Alopecia areata in renal transplant recipient on cyclosporin.
Australas J Dermatol, 37 (1996), pp. 226-227
[62.]
E. Rallis, A. Nasiopoulou, C. Kouskoukis, A. Roussaki-Schulze, E. Koumantaki, A. Karpouzis, et al.
Oral administration of cyclosporin A in patients with severe alopecia areata.
Int J Tissue React, 27 (2005), pp. 107-110
[63.]
J. Shapiro, H. Lui, V. Tron, V. Ho.
Systemic cyclosporine and low-dose prednisone in the treatment of chronic severe alopecia areata: a clinical and immunopathologic evaluation.
JAm Acad Dermatol, 36 (1997), pp. 114-117
[64.]
P. Joly.
The use of metotrexate alone or in combination low doses of oral corticosteroids in the treatment of alopecia totalis or universalis.
J Am Acad Dermatol, 55 (2006), pp. 632-636
[65.]
G. Smedegard, K. Bjork.
Sulphasalazine: mechanism of action in rheumatoid arthritis.
Br Soc Rheumatol, 34 (1995), pp. 7-15
[66.]
C.N. Ellis, M.F. Brown, J.J. Voorhees.
Sulfasalazine for alopecia areata.
J Am Acad Dermatol, 46 (2002), pp. 541-544
[67.]
L. Misery, K. Sannier, M. Chastaing, G. Le Gallic.
Treatment of alopecia areata with sulfasalazine.
J Eur Acad Dermatol, 21 (2007), pp. 547-548
[68.]
F.M. Camacho, M.J. García-Hernández.
Zinc aspartate, biotin, and clobetasol propionate in the treatment of alopecia areata in childhood.
Pediatr Dermatol, 16 (1999), pp. 336-338
[69.]
J. Ferrando, R. Grimalt, L. Lacueva, R. Artuch, M.A. Vilaseca.
Biotinidase activity and biotin treatment in alopecia areata.
Second Intercontinental Meeting of Hair Research Societies,
[70.]
R.D. Ead.
Oral zinc sulphate in alopecia areata-a double blind trial.
Br J Dermatol, 104 (1981), pp. 483-484
[71.]
W. Posten, J. Swan.
Recurrence of alopecia areata in a patient receiving etanercept injections.
Arch Dermatol, 141 (2005), pp. 759-760
[72.]
B.E. Strober, K. Siu, A.F. Alexis, G. Kim, K. Washenik, A. Sinha, et al.
Etanercept does not effectively treat moderate to severe alopecia areata: an open-label study.
J Am Acad Dermatol, 52 (2005), pp. 1082-1084
[73.]
L. Ettefagh, S. Nedorost, P. Mirmirani.
Alopecia areata in a patient using infliximab: new insights into the role of tumor necrosis factor on human hair follicles.
Arch Dermatol, 140 (2004), pp. 1012
[74.]
U. Kaelin, A.S. Hassan, L.R. Braathen, N. Yawalkar.
Treatment of alopecia areata partim universalis with efalizumab.
J Am Acad Dermatol, 55 (2006), pp. 529-532
[75.]
V.H. Price, M.K. Hordinsky, E.A. Olsen, J.L. Roberts, E.C. Siegfried, E.S. Rafal, et al.
Subcutaneous efalizumab is not effective in the treatment of alopecia areata.
J Am Acad Dermatol, 58 (2008), pp. 395-402
[76.]
K. Bui, S. Polisetty, H. Gilchrist, S.M. Jackson, J. Frederic.
Successful treatment of alopecia universalis with alefacept: a case report and review of the literature.
Cutis, 81 (2008), pp. 431-434
[77.]
M.P. Hefferman, M.Y. Hurley, K.S. Martin, D.L. Smith, M.J. Anadkat.
Alefacept for alopecia areata.
Arch Dermatol, 141 (2005), pp. 1513-1516
[78.]
M.R. Namazi.
The potential efficacy of thalidomide in the treatment of recalcitrant alopecia areata.
Med Hypotheses, 60 (2003), pp. 513-514
[79.]
I.C. Hay, M. Jamieson, A.D. Ormerod.
Randomized trial of aromatherapy. Successful treatment for alopecia areata.
Arch Dermatol, 134 (1998), pp. 1349-1352
[80.]
K.J. McElwee, S. Niiyama, P. Freyschmidt-Paul, E. Wenzel, S. Kissling, J.P. Sundberg, et al.
Dietary soy oil content and soyderived phytoestrogen genistein increase resistance to alopecia areata onset in C3H/Hej mice.
Exp Dermatol, 12 (2003), pp. 30-36
[81.]
G. Pierini, M. Zara, R. Cipriani, C. Carrazo, A. Preti, F. Gava, et al.
Imipramine in alopecia areata. A double-blind, placebocontrolled study.
Psychother Psychosom, 61 (1994), pp. 195-198
Copyright © 2009. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
Idiomas
Actas Dermo-Sifiliográficas
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?