Archives of Dermatological Research

, Volume 301, Issue 5, pp 373–380

Combination therapy with oral PUVA and corticosteroid for recalcitrant alopecia areata

  • Taisuke Ito
  • Masahiro Aoshima
  • Natsuho Ito
  • Izumi Uchiyama
  • Keiko Sakamoto
  • Tetsuya Kawamura
  • Hiroaki Yagi
  • Hideo Hashizume
  • Masahiro Takigawa
Original Paper

DOI: 10.1007/s00403-009-0936-8

Cite this article as:
Ito, T., Aoshima, M., Ito, N. et al. Arch Dermatol Res (2009) 301: 373. doi:10.1007/s00403-009-0936-8

Abstract

Alopecia areata (AA) is regarded as a tissue-specific autoimmune disease for which several therapies have been suggested to modify the immune reaction against HFs, such as contact immunotherapy, psoralen plus ultraviolet A (PUVA), corticosteroids, cyclosporine, minoxidil, and dithranol. However, severe type AA, such as alopecia totalis (AT) and alopecia universalis (AU), often show resistance against these therapies. We applied a combination therapy with oral corticosteroid and oral PUVA for intractable cases of AT and AU. These patients took 20 mg/day corticosteroid and were irradiated with UVA on the whole body 2 h after taking methoxsalen for 1 month. In all patients, the terminal hair on the whole scalp regrew after 2 months. Two patients had a relapse of hair loss 3 months after the termination of the treatment. FACS analysis revealed that the CD4+CD25high and CD4+CD25+FOXP3+ Treg population in PBMC was increased after the combination therapy. Furthermore, the number of infiltrating cells decreased and FOXP3+ cells were often found in lesion skin after the combination therapy. Mitogen-induced proliferation tests showed low responses against PHA and Con A after the combination therapy. Taken together, the combination therapy may modify the systemic immune system and increase the number of Treg cells, resulting in improvement of recalcitrant AA.

Keywords

Alopecia areataPUVACorticosteroidRegulatory T cellCD8

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Taisuke Ito
    • 1
  • Masahiro Aoshima
    • 1
  • Natsuho Ito
    • 1
  • Izumi Uchiyama
    • 1
  • Keiko Sakamoto
    • 1
  • Tetsuya Kawamura
    • 1
  • Hiroaki Yagi
    • 1
  • Hideo Hashizume
    • 1
  • Masahiro Takigawa
    • 1
  1. 1.Department of DermatologyHamamatsu University School of MedicineHamamatsuJapan