Comparative study between the efficacies of azathioprine and mesalazine in the treatment of severe alopecia areata

Abstract

Background Various systemic agents have been assessed for treatment of alopecia areata; however, there is a paucity of comparative studies. Aim To compare the efficacy of azathioprine versus mesalazine in the treatment of severe alopecia areata. Methods Our study was carried out in 30 patients with severe alopecia areata divided into two groups, group A: fifteen patients were treated by azathioprine in an oral dose of 1–2 mg/kg/day and group B: fifteen patients were treated by mesalazine in an oral dose of 15–30 mg/kg/day in two divided doses. The treatment was considered effective if percentage regrowth of hair was determined by change in SALT score >50 from base line after 6 months of treatment. The treatment was continued for 3–6 months after complete remission to minimize the risk of relapse. The dose was gradually tapered during this time. Results The study found that there is statistically significant difference between mean SALT scores before treatment and after 6 months of treatment in both groups. In group A, SALT score at base line was 84.42 ± 17.41, after 6 months it was 35.95 ± 35.79 (p value 0.04). In group B, SALT score at base line was 73.06 ± 22.10, after 6 months it was 23.04± 12.27 (p value 0.037). Changes in SALT score after 6 months were −27.74 ± 20.66 in group A and −60.42±38.41 in group B (p value 0.055). Conclusion Mesalazine may be considered as effective as azathioprine with lesser side effects. Azathioprine is also considered safe. However, a large group study should be performed to confirm these findings.

Efficacy of mesalazine in children with moderate to severe alopecia areata: case series of 18 patients

“… 2 In 2021, Mahgoob et al compared mesalazine with azathioprine in 30 adult and child patients with severe AA and showed that both are effective for AA, with mesalazine showing fewer side effects. 9 Our study observed a mean relative SALT reduction of 66.8% after 12 months of treatment with mesalazine, a result similar to a study that showed a 67.7% reduction in adolescents with AA using tofacitinib; 10 however, at a much lower cost of treatment in the case of mesalazine. The present study highlights the potential benefits of mesalazine for managing patients with AA.…”

Alopecia areata. Diagnostic and therapeutic recommendations of the Polish Society of Dermatology. Part 2: Treatment

“…Isolated cases of successful treatment of alopecia areata with azathioprine at a dose of 1-2 mg/kg/day have been reported [57,58]. The data are currently insufficient to recommend this treatment, although it may be considered in the case of resistance to other therapeutic methods.…”

“…Opisano pojedyncze przypadki skutecznego leczenia łysienia plackowatego azatiopryną w dawce 1-2 mg/kg m.c./dobę [57,58]. Dane nie są obecnie wystarczające do rekomendowania tego leczenia, choć może być rozważane w przypadku oporności na inne metody terapeutyczne.…”

Role of both Azathioprine and methotrexate in Management of Alopecia Areata: Review Article

“…Because of the high morbidity rate associated with systemic steroid use, azathioprine may be a viable alternative therapy for decreasing steroid use in patients on oral corticosteroids. Adjuvant treatment for patients with severe and resistant AA may include steroid and azathioprine combination therapy (9) .…”