Treatment of Alopecia Areata with Simvastatin/Ezetimibe

Abstract

Alopecia areata (AA) is an autoimmune disorder characterized by T lymphocytic infiltrates around the bulbar region of hair follicles. Statins have surfaced as potential therapeutic agents for AA, partly because of their modulation of the JAK/STAT pathway. Some data indicate that statins are a possible option for acute, but not chronic, longstanding AA. Animal studies suggest that treatment with statins increases CD4/CD25/Foxp3 populations in AA-affected mice.

Cholesterol homeostasis: Links to hair follicle biology and hair disorders

“…It should be stated that this case study was not a randomised control trial and care should be taken in interpreting these observations, considering the potential for spontaneous regrowth in this disorder. Indeed, the extent of regrowth in response to this therapy varies significantly between studies, ranging from <20% to ‘significant’, with patients displaying more severe AA receiving no benefit …”

“…In addition, JAK/STAT inhibitors have proven useful in restoring hair growth in AA patients, by attenuating production of inflammatory cytokines (IL‐2, IL‐15 and interferon‐γ) by cytotoxic T lymphocytes . It is likely that, as seen with JAK/STAT inhibitors, statin‐mediated inhibition of inflammatory cytokine signalling is a mechanism by which statins can help treat acute episodes of AA …”

“…Whereas both statins and ezetimibe are cholesterol‐lowering therapies, the hair growth restoration observed in AA patients is most likely to occur as a result of both the immunomodulatory activity of these drugs and their inhibitory activity against the JAK/STAT pathway . Infiltration of CD4 + and CD8 + lymphocytes is a key feature of AA .…”

“…Whereas lipids are understood to impact on HF biology, not least through the HF association with the lipid‐rich sebaceous gland, the specific functions modulated by cholesterol are less well understood. Associations have been made between sterol levels and certain hair disorders, and lipid‐modulatory drug therapies have been reported to cause both hair loss and hair growth …”

Mevastatin promotes healing by targeting caveolin-1 to restore EGFR signaling

“…Topical statins represent a promising new therapeutic approach for the treatment of chronic wounds, and several studies have shown that statins exert beneficial pleiotropic effects extending beyond reducing systemic cholesterol levels. These include antiinflammatory, antibacterial, anticancer, and improved endothelial function, suggesting that statins may have beneficial effects in the treatment of various diseases (7)(8)(9)(10)(11)(12)(13)(14). In addition, statins are currently recommended as a standard of care therapy for DM, and systemic statin use has been shown to correlate with increased wound healing in patients with chronic wounds (8,15,16).…”