Alopecia Universalis Treated With Oral Cyclosporine a and Prednisolone: Immunologic Studies

Abstract

Alopecia universalis is a refractory condition. Although the cause of this disease is unknown, immunologic abnormalities have recently been suspected. Thus, we treated six cases of refractory alopecia universalis with immunotherapy. Oral administration of cyclosporine A (2.5 mg/kg) and prednisolone (5 mg/day) resulted in marked symptomatic improvement. Cyclosporine A did not produce any side effects because the administered dosage was relatively low. At present, more than 6 months after the cessation of treatment, recurrence of alopecia has not been seen. Oral administration of low-dose cyclosporine A and prednisolone is considered to be an effective treatment for this disease. Immunologic examination of peripheral blood demonstrated improvement of immunologic function. In particular, CD8-positive T cells, NK cells, and C3, which had been reduced, were increased. A reduction in active CD4 cells, eosinophils, and circulating immune complexes was observed. Histology with fluorescent antibodies showed T-cell infiltration around the hair matrixes. This phenomenon was no longer observed after treatment. These improvements in immunologic function were seen in parallel with the resolution of the clinical symptoms, indicating that immunologic abnormalities are related to this disease.

Alopecia areata presenting in 2 kidney-pancreas transplant recipients taking cyclosporine

“…Additional studies utilizing cyclosporine, with or without combination corticosteroids, have yielded similarly unpredictable results. [22][23][24] To explain this partial success, investigators have suggested that 6 mg/kg per day may be a critical threshold dose below which cyclosporine will not suppress AA. [6][7][8][9]11,12 Details of the transplant-associated cases of AA are shown in Table I.…”

Treatment of Severe Alopecia Areata: Combination Therapy Using Systemic Cyclosporine A with Low Dose Corticosteroids

“…However, the results of previous studies have shown variable success rates 13,14,22 and the therapeutic range of the trough CsA concentration varied from study to study 12,18 . Teshima et al 12 treated six AU patients using oral CsA at 2.5 mg/kg/day and prednisolone was started at a dose of 5 mg/day for 7 months. The CsA concentration was maintained at 30 to 50 ng/ml.…”

“…Combination therapy using systemic CsA and low-dose corticosteroid to treat AA has been previously reported on [12][13][14] , and TDM has helped to reduce the toxicity of these drugs, such as by preventing life-threatening infections via administering concentration-oriented therapy rather than doseoriented therapy 20,21 . However, the results of previous studies have shown variable success rates 13,14,22 and the therapeutic range of the trough CsA concentration varied from study to study 12,18 .…”

“…Since CsA acts as an early immune modulator at the induction phase, combination therapy with CsA and corticosteroids may have synergistic effects on immunosuppression 11 . Although several studies have used systemic CsA in combination with corticosteroids for the treatment of severe AA [12][13][14] , the results have been variable. Many studies that used CsA as a treatment modality recommended monitoring the peripheral blood concentration of CsA to evaluate the efficacy of treatment and avoid CsA-related toxicity [15][16][17] .…”

Partial Response of Severe Alopecia areata to Cyclosporine A

“…On the other hand, the well-known hypertrichotic side effect of CsA has been suggested to be due to prolongation of the anagen phase of the hair cycle [4]. CsA has been reported to restore hair growth in the DEBR rat model for AA [5], and some trials recommend its use in combination with oral steroids [6, 7]. On the other hand, AA has been described in renal or liver transplant recipients on high doses of CsA [8, 9, 10], and CsA failed to restore hair growth after 3 months in a case of severe AA [11].…”