Could azathioprine be considered as a therapeutic alternative in the treatment of alopecia areata? A pilot study

Abstract

Alopecia areata is an autoimmune disease resulting in partial or total nonscarring hair loss and the treatment of severe alopecia areata is difficult. The aim of this study was to evaluate the efficacy and safety of azathioprine as a systemic monotherapy for moderate to severe alopecia areata. A total of 20 patients [14 men (70%) and six women (30%)] with minimum 6 months history of alopecia areata were included. The extent of scalp hair regrowth during and after the completion of the 6 months treatment was evaluated by the Severity of Alopecia Tool (the SALT score). The daily drug intake was calculated as 2 mg/kg of body weight. Mean duration of current episode of scalp hair loss was 26.4 (26.4 ± 17) months. Mean regrowth percentage was 52.3% (52.3 ± 38.4). Mean hair loss percentage before treatment was 72.7% (72.7 ± 28.3) compared with 33.5% (33.5 ± 30.7) after 6 months of azathioprine treatment. This showed a highly significant statistical difference (Paired t-test, CI 95% =21.5-54.1). Mean hair loss score (S(0) -S(5) ) before treatment was 3.9 (3.9 ± 1.6) and after 6 months of azathioprine treatment was 1.8 (1.8 ± 1.3). Assessment showed significant difference from baseline score (sign test, P < 0.0001). No significant statistical difference was observed with respect to gender before and after azathioprine treatment. Treatment with azathioprine as a systemic monotherapy clinically produces relevant improvement in moderate-to-severe alopecia areata. Generally azathioprine is a low-cost and well-tolerated drug and with controlled studies on larger number of patients, long-term efficacy and safety of this treatment should be investigated.

Current and future pharmacotherapy for alopecia areata

“…reported important hair regrowth in 20 patients with alopecia areata with a dose of 2 mg/kg in a lapse of 6 months [81]. However, more studies are needed to support these results.…”

Hair Loss in Patients with Inflammatory Bowel Disease

“…15 Furthermore, although none of them were taking immunomodulators at the time of alopecia, 2 had subsequent regrowth of hair after treatment with azathioprine. 15,16 Despite the fact that AA is not a recognized extraintestinal manifestation of IBD, 23 these cases, all of whom had AA, suggest that there may be an association between the 2 conditions. Supporting this, a case series assessing autoimmune disorders associated with IBD found an increased prevalence of AA in patients with UC, but not CD, compared with controls.…”

“…Two patients with CD had complete reversal of AA within 6 months of starting azathioprine. 15,16 Methotrexate Like thiopurines, methotrexate targets rapidly dividing cells and as a result causes death of hair follicle cells and subsequent hair loss. Alopecia is occasionally reported as a side effect of methotrexate in IBD, although usually not requiring drug withdrawal.…”

New Modalities in the Treatment of Refractory Alopecia Areata

“…An open-label uncontrolled study and a recently published prospective study suggested that AZT Might be an alternative [49,50].…”