Skip to main content

Advertisement

SpringerLink
Log in

Treating Alopecia Areata: Current Practices Versus New Directions

  • Review Article
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Alopecia areata (AA) is non-scarring hair loss resulting from an autoimmune disorder. Severity varies from patchy hair loss that often spontaneously resolves to severe and chronic cases that can progress to total loss of scalp and body hair. Many treatments are available; however, the efficacy of these treatments has not been confirmed, especially in severe cases, and relapse rates are high. First-line treatment often includes corticosteroids such as intralesional or topical steroids for mild cases and systemic steroids or topical immunotherapy with diphenylcyclopropenone or squaric acid dibutylester in severe cases. Minoxidil and bimatoprost may also be recommended, usually in combination with another treatment. Ongoing research and new insights into mechanisms have led to proposals of innovative therapies. New directions include biologics targeting immune response as well as lasers and autologous platelet-rich plasma therapy. Preliminary data are encouraging, and it is hoped this research will translate into new options for the treatment of AA in the near future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Gilhar A, Kalish RS. Alopecia areata: a tissue specific autoimmune disease of the hair follicle. Autoimmun Rev. 2006;5(1):64–9.

    Article  PubMed  Google Scholar 

  2. McElwee K, Freyschmidt-Paul P, Ziegler A, Happle R, Hoffmann R. Genetic susceptibility and severity of alopecia areata in human and animal models. Eur J Dermatol. 2001;11(1):11–6.

    CAS  PubMed  Google Scholar 

  3. Messenger AG, McKillop J, Farrant P, McDonagh AJ, Sladden M. British Association of Dermatologists’ guidelines for the management of alopecia areata 2012. Br J Dermatol. 2012;166(5):916–26.

    Article  CAS  PubMed  Google Scholar 

  4. Alsantali A. Alopecia areata: a new treatment plan. Clin Cosmet Investig Dermatol. 2011;4:107–15.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Delamere FM, Sladden MM, Dobbins HM, Leonardi-Bee J. Interventions for alopecia areata. Cochrane Database Syst Rev. 2008;2:CD004413.

    Google Scholar 

  6. MacDonald Hull SP, Wood ML, Hutchinson PE, Sladden M, Messenger AG, British Association of Dermatologists. Guidelines for the management of alopecia areata. Br J Dermatol. 2003;149(4):692–9.

    Article  CAS  PubMed  Google Scholar 

  7. Chang KH, Rojhirunsakool S, Goldberg LJ. Treatment of severe alopecia areata with intralesional steroid injections. J Drugs Dermatol JDD. 2009;8(10):909–12.

    PubMed  Google Scholar 

  8. Abell E, Munro DD. Intralesional treatment of alopecia areata with triamcinolone acetonide by jet injector. Br J Dermatol. 1973;88(1):55–9.

    Article  CAS  PubMed  Google Scholar 

  9. Carnahan MC, Goldstein DA. Ocular complications of topical, peri-ocular, and systemic corticosteroids. Curr Opin Ophthalmol. 2000;11(6):478–83.

    Article  CAS  PubMed  Google Scholar 

  10. Tosti A, Piraccini BM, Pazzaglia M, Vincenzi C. Clobetasol propionate 0.05 % under occlusion in the treatment of alopecia totalis/universalis. J Am Acad Dermatol. 2003;49(1):96–8.

    Article  PubMed  Google Scholar 

  11. Pascher F, Kurtin S, Andrade R. Assay of 0.2 percent fluocinolone acetonide cream for alopecia areata and totalis. Efficacy and side effects including histologic study of the ensuing localized acneform response. Dermatologica. 1970;141(3):193–202.

    Article  CAS  PubMed  Google Scholar 

  12. Olsen EA, Carson SC, Turney EA. Systemic steroids with or without 2 % topical minoxidil in the treatment of alopecia areata. Arch Dermatol. 1992;128(11):1467–73.

    Article  CAS  PubMed  Google Scholar 

  13. Kar BR, Handa S, Dogra S, Kumar B. Placebo-controlled oral pulse prednisolone therapy in alopecia areata. J Am Acad Dermatol. 2005;52(2):287–90.

    Article  PubMed  Google Scholar 

  14. Seiter S, Ugurel S, Tilgen W, Reinhold U. High-dose pulse corticosteroid therapy in the treatment of severe alopecia areata. Dermatol Basel Switz. 2001;202(3):230–4.

    Article  CAS  Google Scholar 

  15. Friedli A, Labarthe MP, Engelhardt E, Feldmann R, Salomon D, Saurat JH. Pulse methylprednisolone therapy for severe alopecia areata: an open prospective study of 45 patients. J Am Acad Dermatol. 1998;39(4 Pt 1):597–602.

    Article  CAS  PubMed  Google Scholar 

  16. Sladden MJ, Hutchinson PE. Is oral pulsed prednisolone useful in alopecia areata? Critical appraisal of a randomized trial. J Am Acad Dermatol. 2005;53(6):1100–1 (author reply 1101).

    Article  PubMed  Google Scholar 

  17. Iorizzo M, Tosti A. Treatments options for alopecia. Expert Opin Pharmacother. 2015;16(15):2343–54.

    Article  PubMed  Google Scholar 

  18. Senila SC, Danescu SA, Ungureanu L, Candrea E, Cosgarea RM. Intravenous methylprednisolone pulse therapy in severe alopecia areata. Indian J Dermatol Venereol Leprol. 2015;81(1):95.

    PubMed  Google Scholar 

  19. Im M, Lee SS, Lee Y, Kim CD, Seo YJ, Lee JH, et al. Prognostic factors in methylprednisolone pulse therapy for alopecia areata. J Dermatol. 2011;38(8):767–72.

    Article  CAS  PubMed  Google Scholar 

  20. Nakajima T, Inui S, Itami S. Pulse corticosteroid therapy for alopecia areata: study of 139 patients. Dermatol Basel Switz. 2007;215(4):320–4.

    Article  CAS  Google Scholar 

  21. Burton JL, Shuster S. Large doses of glucocorticoid in the treatment of alopecia areata. Acta Derm Venereol. 1975;55(6):493–6.

    CAS  PubMed  Google Scholar 

  22. Açıkgöz G, Ozmen I, Cayırlı M, Yeniay Y, Köse O. Pulse methylprednisolone therapy for the treatment of extensive alopecia areata. J Dermatol Treat. 2014;25(2):164–6.

    Article  CAS  Google Scholar 

  23. Staumont-Sallé D, Vonarx M, Lengrand F, Segard M, Delaporte E. Pulse corticosteroid therapy for alopecia areata: long-term outcome after 10 years. Dermatol Basel Switz. 2012;225(1):81–7.

    Article  CAS  Google Scholar 

  24. Ait Ourhroui M, Hassam B, Khoudri I. Treatment of alopecia areata with prednisone in a once-monthly oral pulse. Ann Dermatol Vénéréol. 2010;137(8–9):514–8.

    Article  CAS  PubMed  Google Scholar 

  25. Bin Saif GA, Al- Khawajah MM, Al- Otaibi HM, Al- Roujayee AS, Alzolibani AA, Kalantan HA, et al. Efficacy and safety of oral mega pulse methylprednisolone for severe therapy resistant alopecia areata. Saudi Med J. 2012;33(3):284–91.

    PubMed  Google Scholar 

  26. Lalosevic J, Gajic-Veljic M, Bonaci-Nikolic B, Nikolic M. Combined oral pulse and topical corticosteroid therapy for severe alopecia areata in children: a long-term follow-up study. Dermatol Ther. 2015;28(5):309–17.

    Article  PubMed  Google Scholar 

  27. Wiseman MC, Shapiro J, MacDonald N, Lui H. Predictive model for immunotherapy of alopecia areata with diphencyprone. Arch Dermatol. 2001;137(8):1063–8.

    CAS  PubMed  Google Scholar 

  28. van der Steen PH, Happle R. Topical immunotherapy of alopecia areata. Dermatol Clin. 1993;11(3):619–22.

    PubMed  Google Scholar 

  29. Happle R. Antigenic competition as a therapeutic concept for alopecia areata. Arch Dermatol Res. 1980;267(1):109–14.

    Article  CAS  PubMed  Google Scholar 

  30. Orecchia G, Perfetti L. Alopecia areata and topical sensitizers: allergic response is necessary but irritation is not. Br J Dermatol. 1991;124(5):509.

    Article  CAS  PubMed  Google Scholar 

  31. Singh G, Lavanya M. Topical immunotherapy in alopecia areata. Int J Trichology. 2010;2(1):36.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Tosti A, De Padova MP, Minghetti G, Veronesi S. Therapies versus placebo in the treatment of patchy alopecia areata. J Am Acad Dermatol. 1986;15(2 Pt 1):209–10.

    Article  CAS  PubMed  Google Scholar 

  33. Ro BI. Alopecia areata in Korea (1982–1994). J Dermatol. 1995;22(11):858–64.

    Article  CAS  PubMed  Google Scholar 

  34. Rokhsar CK, Shupack JL, Vafai JJ, Washenik K. Efficacy of topical sensitizers in the treatment of alopecia areata. J Am Acad Dermatol. 1998;39(5 Pt 1):751–61.

    Article  CAS  PubMed  Google Scholar 

  35. Pan R, Liu J, Xuan X, Li B. Chinese experience in the treatment of alopecia areata with diphenylcyclopropenone. J Dermatol. 2015;42(2):220–1.

    Article  PubMed  Google Scholar 

  36. Chiang K, Atanaskova Mesinkovska N, Amoretti A, Piliang MP, Kyei A, Bergfeld WF. Clinical efficacy of diphenylcyclopropenone in alopecia areata: retrospective data analysis of 50 patients. J Am Acad Dermatol. 2014;71(3):595–7.

    Article  PubMed  Google Scholar 

  37. Wilkerson MG, Connor TH, Henkin J, Wilkin JK, Matney TS. Assessment of diphenylcyclopropenone for photochemically induced mutagenicity in the Ames assay. J Am Acad Dermatol. 1987;17(4):606–11.

    Article  CAS  PubMed  Google Scholar 

  38. Tosti A, Piraccini BM, Misciali C, Vincenzi C. Lentiginous eruption due to topical immunotherapy. Arch Dermatol. 2003;139(4):544–5.

    Article  PubMed  Google Scholar 

  39. Micali G, Cicero RL, Nasca MR, Sapuppo A. Treatment of alopecia areata with squaric acid dibutylester. Int J Dermatol. 1996;35(1):52–6.

    Article  CAS  PubMed  Google Scholar 

  40. Case PC, Mitchell AJ, Swanson NA, Vanderveen EE, Ellis CN, Headington JT. Topical therapy of alopecia areata with squaric acid dibutylester. J Am Acad Dermatol. 1984;10(3):447–50.

    Article  CAS  PubMed  Google Scholar 

  41. Tang L, Cao L, Sundberg JP, Lui H, Shapiro J. Restoration of hair growth in mice with an alopecia areata-like disease using topical anthralin. Exp Dermatol. 2004;13(1):5–10.

    Article  CAS  PubMed  Google Scholar 

  42. Tang L, Cao L, Pelech S, Lui H, Shapiro J. Cytokines and signal transduction pathways mediated by anthralin in alopecia areata-affected Dundee experimental balding rats. J Investig Dermatol Symp Proc Soc Investig Dermatol Inc Eur Soc Dermatol Res. 2003;8(1):87–90.

    Article  CAS  Google Scholar 

  43. Fiedler-Weiss VC, Buys CM. Evaluation of anthralin in the treatment of alopecia areata. Arch Dermatol. 1987;123(11):1491–3.

    Article  CAS  PubMed  Google Scholar 

  44. Schmoeckel C, Weissmann I, Plewig G, Braun-Falco O. Treatment of alopecia areata by anthralin-induced dermatitis. Arch Dermatol. 1979;115(10):1254–5.

    Article  CAS  PubMed  Google Scholar 

  45. Bornhövd E, Burgdorf WH, Wollenberg A. Macrolactam immunomodulators for topical treatment of inflammatory skin diseases. J Am Acad Dermatol. 2001;45(5):736–43.

    Article  PubMed  Google Scholar 

  46. Hunter N, Shaker O, Marei N. Diphencyprone and topical tacrolimus as two topical immunotherapeutic modalities. Are they effective in the treatment of alopecia areata among Egyptian patients? A study using CD4, CD8 and MHC II as markers. J Dermatol Treat. 2011;22(1):2–10.

    Article  CAS  Google Scholar 

  47. Feldmann KA, Kunte C, Wollenberg A, Wolfe H. Is topical tacrolimus effective in alopecia areata universalis? Br J Dermatol. 2002;147(5):1031–2.

    Article  CAS  PubMed  Google Scholar 

  48. Price VH, Willey A, Chen BK. Topical tacrolimus in alopecia areata. J Am Acad Dermatol. 2005;52(1):138–9.

    Article  PubMed  Google Scholar 

  49. Ucak H, Kandi B, Cicek D, Halisdemir N, Dertlıoğlu SB. The comparison of treatment with clobetasol propionate 0.05 % and topical pimecrolimus 1 % treatment in the treatment of alopecia areata. J Dermatol Treat. 2012;23(6):410–20.

    Article  CAS  Google Scholar 

  50. Rigopoulos D, Gregoriou S, Korfitis C, Gintzou C, Vergou T, Katrinaki A, et al. Lack of response of alopecia areata to pimecrolimus cream. Clin Exp Dermatol. 2007;32(4):456–7.

    Article  CAS  PubMed  Google Scholar 

  51. Price VH. Double-blind, placebo-controlled evaluation of topical minoxidil in extensive alopecia areata. J Am Acad Dermatol. 1987;16(3 Pt 2):730–6.

    Article  CAS  PubMed  Google Scholar 

  52. Fiedler-Weiss VC. Topical minoxidil solution (1 % and 5 %) in the treatment of alopecia areata. J Am Acad Dermatol. 1987;16(3 Pt 2):745–8.

    Article  CAS  PubMed  Google Scholar 

  53. Zaheri S, Hughes B. Successful use of bimatoprost in the treatment of alopecia of the eyelashes. Clin Exp Dermatol. 2010;35(4):e161–2.

    Article  CAS  PubMed  Google Scholar 

  54. Roseborough I, Lee H, Chwalek J, Stamper RL, Price VH. Lack of efficacy of topical latanoprost and bimatoprost ophthalmic solutions in promoting eyelash growth in patients with alopecia areata. J Am Acad Dermatol. 2009;60(4):705–6.

    Article  PubMed  Google Scholar 

  55. Ochoa BE, Sah D, Wang G, Stamper R, Price VH. Instilled bimatoprost ophthalmic solution in patients with eyelash alopecia areata. J Am Acad Dermatol. 2009;61(3):530–2.

    Article  PubMed  Google Scholar 

  56. Vila TO, Camacho Martinez FM. Bimatoprost in the treatment of eyelash universalis alopecia areata. Int J Trichol. 2010;2(2):86–8.

    Article  Google Scholar 

  57. Zaher H, Gawdat HI, Hegazy RA, Hassan M. Bimatoprost versus mometasone furoate in the treatment of scalp alopecia areata: a pilot study. Dermatol Basel Switz. 2015;230(4):308–13.

    Article  CAS  Google Scholar 

  58. Li AW, Antaya RJ. Successful treatment of pediatric alopecia areata of the scalp using topical bimatoprost. Pediatr Dermatol. 2016;33(5):e282–3.

    Article  PubMed  Google Scholar 

  59. Gupta AK, Ellis CN, Cooper KD, Nickoloff BJ, Ho VC, Chan LS, et al. Oral cyclosporine for the treatment of alopecia areata. A clinical and immunohistochemical analysis. J Am Acad Dermatol. 1990;22(2 Pt 1):242–50.

    Article  CAS  PubMed  Google Scholar 

  60. Shapiro J. Current treatment of alopecia areata. J Investig Dermatol Symp Proc Soc Investig Dermatol Inc Eur Soc Dermatol Res. 2013;16(1):S42–4.

    Article  CAS  Google Scholar 

  61. Brzezińska-Wcisło L, Bergler-Czop B, Wcisło-Dziadecka D, Lis-Święty A. New aspects of the treatment of alopecia areata. Postȩpy Dermatol Alergol. 2014;31(4):262–5.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Strober B, Buonanno M, Clark JD, Kawabata T, Tan H, Wolk R, et al. Effect of tofacitinib, a Janus kinase inhibitor, on haematological parameters during 12 weeks of psoriasis treatment. Br J Dermatol. 2013;169(5):992–9.

    Article  CAS  PubMed  Google Scholar 

  63. Navarro R, Daudén E, Gallo E, Santiago Sánchez-Mateos D, García-Diez A. Alopecia areata during treatment of psoriasis with adalimumab and leflunomide: a case and review of the literature. Skin Pharmacol Physiol. 2012;25(2):107–10.

    Article  CAS  PubMed  Google Scholar 

  64. Gorcey L, Spratt EAG, Leger MC. Alopecia universalis successfully treated with adalimumab. JAMA Dermatol. 2014;150(12):1341–4.

    Article  PubMed  Google Scholar 

  65. Ghoreishi M, Martinka M, Dutz JP. Type 1 interferon signature in the scalp lesions of alopecia areata. Br J Dermatol. 2010;163(1):57–62.

    CAS  PubMed  Google Scholar 

  66. Kooloos WM, de Jong DJ, Huizinga TWJ, Guchelaar H-J. Potential role of pharmacogenetics in anti-TNF treatment of rheumatoid arthritis and Crohn’s disease. Drug Discov Today. 2007;12(3–4):125–31.

    Article  CAS  PubMed  Google Scholar 

  67. Xing L, Dai Z, Jabbari A, Cerise JE, Higgins CA, Gong W, et al. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Nat Med. 2014;20(9):1043–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Ghoreschi K, Jesson MI, Li X, Lee JL, Ghosh S, Alsup JW, et al. Modulation of innate and adaptive immune responses by tofacitinib (CP-690,550). J Immunol. 2011;186(7):4234–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Fehniger TA, Yu H, Cooper MA, Suzuki K, Shah MH, Caligiuri MA. Cutting edge: IL-15 costimulates the generalized Shwartzman reaction and innate immune IFN-gamma production in vivo. J Immunol Baltim Md 1950. 2000;164(4):1643–7.

    CAS  Google Scholar 

  70. Pieri L, Guglielmelli P, Vannucchi AM. Ruxolitinib-induced reversal of alopecia universalis in a patient with essential thrombocythemia. Am J Hematol. 2015;90(1):82–3.

    Article  PubMed  Google Scholar 

  71. Craiglow BG, King BA. Killing two birds with one stone: oral tofacitinib reverses alopecia universalis in a patient with plaque psoriasis. J Invest Dermatol. 2014;134(4):1149–52.

    Article  PubMed  CAS  Google Scholar 

  72. Gupta A, Carviel J, Abramovits W. Efficacy of tofacitinib in treatment of alopecia universalis in two patients. J Eur Acad Dermatol Venereol. 2016;30(8):1373–8.

    Article  CAS  PubMed  Google Scholar 

  73. Mackay-Wiggan J. An open-label pilot study to evaluate the efficacy of tofacitinib in moderate to severe alopecia areata, totalis and universalis [online]. 2014. Available from: http://clinicaltrials.gov/ct2/show/NCT02299290.

  74. Mackay-Wiggan J. An open-label pilot study to evaluate the efficacy of ruxolitinib in moderate to severe alopecia areata. 2014. Available from: https://clinicaltrials.gov/ct2/show/NCT01950780.

  75. Ortiz-Ibáñez K, Alsina MM, Muñoz-Santos C. Tofacitinib and other kinase inhibitors in the treatment of psoriasis. Actas Dermo-Sifiliogr. 2013;104(4):304–10.

    Article  Google Scholar 

  76. No authors listed. Tofacitinib. Drugs R D. 2010;10(4):271–84 (Erratum appears in Drugs R D. 2012;12(1):41–3).

  77. Tefferi A, Pardanani A. Serious adverse events during ruxolitinib treatment discontinuation in patients with myelofibrosis. Mayo Clin Proc. 2011;86(12):1188–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Quintás-Cardama A, Vaddi K, Liu P, Manshouri T, Li J, Scherle PA, et al. Preclinical characterization of the selective JAK1/2 inhibitor INCB018424: therapeutic implications for the treatment of myeloproliferative neoplasms. Blood. 2010;115(15):3109–17.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  79. Yamaoka K, Tanaka Y. Targeting the Janus kinases in rheumatoid arthritis: focus on tofacitinib. Expert Opin Pharmacother. 2014;15(1):103–13.

    Article  CAS  PubMed  Google Scholar 

  80. Witthuhn BA, Silvennoinen O, Miura O, Lai KS, Cwik C, Liu ET, et al. Involvement of the Jak-3 Janus kinase in signalling by interleukins 2 and 4 in lymphoid and myeloid cells. Nature. 1994;370(6485):153–7.

    Article  CAS  PubMed  Google Scholar 

  81. Riese RJ, Krishnaswami S, Kremer J. Inhibition of JAK kinases in patients with rheumatoid arthritis: scientific rationale and clinical outcomes. Best Pract Res Clin Rheumatol. 2010;24(4):513–26.

    Article  CAS  PubMed  Google Scholar 

  82. Leonard WJ, O’Shea JJ. Jaks and STATs: biological implications. Annu Rev Immunol. 1998;16:293–322.

    Article  CAS  PubMed  Google Scholar 

  83. Vijayakrishnan L, Venkataramanan R, Gulati P. Treating inflammation with the Janus kinase inhibitor CP-690,550. Trends Pharmacol Sci. 2011;32(1):25–34.

    Article  CAS  PubMed  Google Scholar 

  84. Parganas E, Wang D, Stravopodis D, Topham DJ, Marine JC, Teglund S, et al. Jak2 is essential for signaling through a variety of cytokine receptors. Cell. 1998;93(3):385–95.

    Article  CAS  PubMed  Google Scholar 

  85. Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent. 2001;10(4):225–8.

    Article  CAS  PubMed  Google Scholar 

  86. Watt-Smith S. Dental and craniofacial applications of platelet-rich plasma. Br Dent J. 2005;199(12):799.

    Article  Google Scholar 

  87. Lin SS, Montemurro NJ, Krell ES. Orthobiologics in foot and ankle surgery. J Am Acad Orthop Surg. 2016;24(2):113–22.

    Article  PubMed  Google Scholar 

  88. Bhanot S, Alex JC. Current applications of platelet gels in facial plastic surgery. Facial Plast Surg FPS. 2002;18(1):27–33.

    Article  PubMed  Google Scholar 

  89. Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2004;62(4):489–96.

    Article  Google Scholar 

  90. Tomita Y, Akiyama M, Shimizu H. PDGF isoforms induce and maintain anagen phase of murine hair follicles. J Dermatol Sci. 2006;43(2):105–15.

    Article  CAS  PubMed  Google Scholar 

  91. Takakura N, Yoshida H, Kunisada T, Nishikawa S, Nishikawa SI. Involvement of platelet-derived growth factor receptor-alpha in hair canal formation. J Invest Dermatol. 1996;107(5):770–7.

    Article  CAS  PubMed  Google Scholar 

  92. Li ZJ, Choi H-I, Choi D-K, Sohn K-C, Im M, Seo Y-J, et al. Autologous platelet-rich plasma: a potential therapeutic tool for promoting hair growth. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2012;38(7 Pt 1):1040–6.

    CAS  Google Scholar 

  93. Trink A, Sorbellini E, Bezzola P, Rodella L, Rezzani R, Ramot Y, et al. A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata. Br J Dermatol. 2013;169(3):690–4.

    Article  CAS  PubMed  Google Scholar 

  94. Sohn K-C, Shi G, Jang S, Choi D-K, Lee Y, Yoon T-J, et al. Pitx2, a beta-catenin-regulated transcription factor, regulates the differentiation of outer root sheath cells cultured in vitro. J Dermatol Sci. 2009;54(1):6–11.

    Article  CAS  PubMed  Google Scholar 

  95. El-Sharkawy H, Kantarci A, Deady J, Hasturk H, Liu H, Alshahat M, et al. Platelet-rich plasma: growth factors and pro- and anti-inflammatory properties. J Periodontol. 2007;78(4):661–9.

    Article  CAS  PubMed  Google Scholar 

  96. Amable PR, Carias RBV, Teixeira MVT, da Cruz Pacheco I, Corrêa do Amaral RJF, Granjeiro JM, et al. Platelet-rich plasma preparation for regenerative medicine: optimization and quantification of cytokines and growth factors. Stem Cell Res Ther. 2013;4(3):67.

  97. Yoshimura A, Wakabayashi Y, Mori T. Cellular and molecular basis for the regulation of inflammation by TGF-beta. J Biochem (Tokyo). 2010;147(6):781–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. Ovidio R d’. Limited effectiveness of platelet-rich-plasma treatment on chronic severe alopecia areata. Hair Ther Transplant [online]. 2014 [cited 2016 Feb 18];04(01). Available from: http://www.omicsgroup.org/journals/limited-effectiveness-of-plateletrichplasma-treatment-on-chronic-severe-alopecia-areata-2167-0951.1000116.php?aid=24661.

  99. Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update: part II. Treatment. J Am Acad Dermatol. 2010;62(2):191–202 (quiz 203–4).

  100. Singh S. Role of platelet-rich plasma in chronic alopecia areata: Our centre experience. Indian J Plast Surg Off Publ Assoc Plast Surg India. 2015;48(1):57–9.

    Article  Google Scholar 

  101. Gkini M-A, Kouskoukis A-E, Rigopoulos D, Kouskoukis K. Platelet-rich plasma as a potential treatment for noncicatricial alopecias. Int J Trichol. 2015;7(2):54–63.

    Article  Google Scholar 

  102. Mackay-Wiggan J. An open-label single-arm clinical trial to evaluate the efficacy of abatacept in moderate to severe patch type alopecia areata [online]. 2013 [cited 2016 Feb 25]. Available from: https://clinicaltrials.gov/ct2/show/NCT02018042?term=NCT02018042&rank=1.

  103. Moreland L, Bate G, Kirkpatrick P. Abatacept. Nat Rev Drug Discov. 2006;5(3):185–6.

    Article  CAS  PubMed  Google Scholar 

  104. Novák Z, Bónis B, Baltás E, Ocsovszki I, Ignácz F, Dobozy A, et al. Xenon chloride ultraviolet B laser is more effective in treating psoriasis and in inducing T cell apoptosis than narrow-band ultraviolet B. J Photochem Photobiol B. 2002;67(1):32–8.

    Article  PubMed  Google Scholar 

  105. McMichael AJ. Excimer laser: a module of the alopecia areata common protocol. J Investig Dermatol Symp Proc. 2013;16(1):S77–9.

    Article  CAS  PubMed  Google Scholar 

  106. Al-Mutairi N. 308-nm excimer laser for the treatment of alopecia areata in children. Pediatr Dermatol. 2009;26(5):547–50.

    Article  PubMed  Google Scholar 

  107. Byun JW, Moon JH, Bang CY, Shin J, Choi GS. Effectiveness of 308-nm excimer laser therapy in treating alopecia areata, determined by examining the treated sides of selected alopecic patches. Dermatol Basel Switz. 2015;231(1):70–6.

    Article  CAS  Google Scholar 

  108. Shin BS, Furuhashi T, Nakamura M, Torii K, Morita A. Impaired inhibitory function of circulating CD4+CD25+ regulatory T cells in alopecia areata. J Dermatol Sci. 2013;70(2):141–3.

    Article  CAS  PubMed  Google Scholar 

  109. Castela E, Le Duff F, Butori C, Ticchioni M, Hofman P, Bahadoran P, et al. Effects of low-dose recombinant interleukin 2 to promote T-regulatory cells in alopecia areata. JAMA Dermatol. 2014;150(7):748–51.

    Article  CAS  PubMed  Google Scholar 

  110. Ali A, Martin JM. Hair growth in patients alopecia areata totalis after treatment with simvastatin and ezetimibe. J Drugs Dermatol. 2010;9(1):62–4.

    PubMed  Google Scholar 

  111. Robins DN. Case reports: alopecia universalis: hair growth following initiation of simvastatin and ezetimibe therapy. J Drugs Dermatol. 2007;6(9):946–7.

    PubMed  Google Scholar 

  112. Lattouf C, Jimenez JJ, Tosti A, Miteva M, Wikramanayake TC, Kittles C, et al. Treatment of alopecia areata with simvastatin/ezetimibe. J Am Acad Dermatol. 2015;72(2):359–61.

    Article  PubMed  Google Scholar 

  113. Namazi MR. Statins: novel additions to the dermatologic arsenal? Exp Dermatol. 2004;13(6):337–9.

    Article  CAS  PubMed  Google Scholar 

  114. Krysiak R, Zmuda W, Okopien B. The effect of ezetimibe, administered alone or in combination with simvastatin, on lymphocyte cytokine release in patients with elevated cholesterol levels. J Intern Med. 2012;271(1):32–42.

    Article  CAS  PubMed  Google Scholar 

  115. Schafer PH, Day RM. Novel systemic drugs for psoriasis: mechanism of action for apremilast, a specific inhibitor of PDE4. J Am Acad Dermatol. 2013;68(6):1041–2.

    Article  PubMed  Google Scholar 

  116. Keren A, Shemer A, Ullmann Y, Paus R, Gilhar A. The PDE4 inhibitor, apremilast, suppresses experimentally induced alopecia areata in human skin in vivo. J Dermatol Sci. 2015;77(1):74–6.

    Article  CAS  PubMed  Google Scholar 

  117. Palfreeman AC, McNamee KE, McCann FE. New developments in the management of psoriasis and psoriatic arthritis: a focus on apremilast. Drug Des Devel Ther. 2013;7:201–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, University of Toronto School of Medicine, Toronto, ON, Canada

    Aditya K. Gupta

  2. Mediprobe Research Inc., 645 Windermere Road, London, ON, N5X 2P1, Canada

    Aditya K. Gupta & Jessie Carviel

  3. The Department of Medicine, Baylor University Medical Center, Dallas, TX, USA

    William Abramovits

  4. The Departments of Dermatology and Family Practice, University of Texas Southwestern Medical School, Dallas, TX, USA

    William Abramovits

  5. Dermatology Treatment and Research Center, Dallas, TX, USA

    William Abramovits

Authors
  1. Aditya K. Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jessie Carviel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William Abramovits
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aditya K. Gupta.

Ethics declarations

Funding

No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of interest

Aditya K. Gupta, Jessie Carviel, and William Abramovits have no conflicts of interest that are directly relevant to the content of this manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gupta, A.K., Carviel, J. & Abramovits, W. Treating Alopecia Areata: Current Practices Versus New Directions. Am J Clin Dermatol 18, 67–75 (2017). https://doi.org/10.1007/s40257-016-0230-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-016-0230-4

Keywords

Search

Navigation