Combination Therapy with Cyclosporine and Psoralen Plus Ultraviolet A in the Patients with Severe Alopecia Areata: A Retrospective Study with a Self-Controlled Design

Abstract

BackgroundAlopecia areata (AA) is believed to be an organ-specific autoimmune disease in which a mononuclear cell infiltrate develops in and around anagen hair follicles. There is no definitive therapy for AA.ObjectiveWe sought to determine whether the combination therapy of cyclosporine and psoralen plus ultraviolet A (PUVA) could be an effective treatment for severe AA.MethodsA total of 41 patients with severe AA were treated with oral cyclosporine and topical PUVA. Cyclosporine was given at an initial daily dose of 200 mg for adult and 100 mg for children for periods of up to 16 weeks. Eight-methoxypsoralen (Methoxsalen) was applied topically 20 minutes prior to ultraviolet A (UVA) exposure, and the patients were irradiated with UVA twice a week for 16 weeks.ResultsOf the total 41 patients, 2 (7.3%) patients were lost to follow-up, and 1 (2.4%) patient discontinued the treatment due to abdominal discomfort. Six (14.6%) patients were treated for less than 12 weeks. Of remaining 32 patients, 3 (9.4%) showed excellent response, 3 (9.4%) showed good response, 12 (37.5%) showed fair response, and 14 (43.7%) showed poor response.ConclusionAlthough limited by its uncontrolled character, this study shows that the combination therapy with cyclosporine and PUVA may be an additional choice for severe and recalcitrant AA.

Alopecia areata universalis in a dog

“…In the present case of AAU the owner dated the onset of alopecia around May–June 2011 and hair regrowth was first reported on 22 April 2013, 2 months after initiating ciclosporin treatment and within 2 years of the disease becoming apparent. In contrast with the common relapses reported in human cases treated with ciclosporin, after 5 months without treatment the dog remained stable with no signs of relapsing, a fact that increases the probability of spontaneous partial resolution.…”

Extensive alopecia areata is reversed by IL-12/IL-23p40 cytokine antagonism

“…1 Although it has a large effect on patients' quality of life and poses a large economic burden, treatment options for patients with AA are limited. 2,3 For more extensive alopecia forms, such as total scalp (totalis) or body (universalis) AA, for which spontaneous regrowth is rare, 1 immunosuppressants (systemic corticosteroids, cyclosporine A, and Janus kinase inhibitors) have shown some efficacy but are associated with side effects that preclude long-term use. 2,3 Furthermore, hair loss recurs shortly after cessation of treatment.…”

“…2,3 For more extensive alopecia forms, such as total scalp (totalis) or body (universalis) AA, for which spontaneous regrowth is rare, 1 immunosuppressants (systemic corticosteroids, cyclosporine A, and Janus kinase inhibitors) have shown some efficacy but are associated with side effects that preclude long-term use. 2,3 Furthermore, hair loss recurs shortly after cessation of treatment. 3 Cytokines driving hair loss are not well understood, 1 hindering the targeted therapeutic development seen with other skin diseases.…”

“…2,3 Furthermore, hair loss recurs shortly after cessation of treatment. 3 Cytokines driving hair loss are not well understood, 1 hindering the targeted therapeutic development seen with other skin diseases. 4 Our recent study in a well-characterized group of 27 patients with AA associated the AA signature with robust T H 2 and IL-23p19 and IL-23/IL-12p40 activation in addition to the T H 1 skewing that has been the previous focus.…”

New Modalities in the Treatment of Refractory Alopecia Areata

“…No randomized controlled trials for neither PUVA nor narrow band ultraviolet B (nbUVB) treatments have been found. A recent study suggested that the combination therapy with topical Cyc and PUVA may be an additional choice for severe and recalcitrant AA [65]. Four patients were reported responding by both clinically and histopathologically to UVA1 therapy [66].…”