Comparison of the topical <scp>FK</scp>506 and clobetasol propionate as first‐line therapy in the treatment of early alopecia areata

Jung, Kyu-In; Gye, Ji Won; Park, Minkee K.; Park, Byung Cheol

doi:10.1111/ijd.13676

Cited by 12 publications

(14 citation statements)

References 5 publications

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“…For example, the immunosuppressive drug FK506 (tacrolimus) 334,335 downregulates MHC class I expression and has been shown to protect HFs from IFNγ‐induced IP collapse in ex vivo studies 76 . Despite some success in rodent models, 336,337 clinical trials with topical FK506 have been unsuccessful, probably due to poor skin penetration 338‐340 . However, in a case report systemic FK506 produced a hair growth response 341 .…”

Section: Therapeutic Perspectivesmentioning

confidence: 99%

Hair follicle immune privilege and its collapse in alopecia areata

Bertolini

McElwee

Gilhar

et al. 2020

Experimental Dermatology

166

157

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Anagen stage hair follicles (HFs) exhibit “immune privilege (IP)” from the level of the bulge downwards to the bulb. Both passive and active IP mechanisms protect HFs from physiologically undesired immune responses and limit immune surveillance. IP is relative, not absolute, and is primarily based on absent, or greatly reduced, intra‐follicular antigen presentation via MHC class I and II molecules, along with prominent expression of “no danger” signals like CD200 and the creation of an immunoinhibitory signalling milieu generated by the secretory activities of HFs. Perifollicular mast cells, Tregs and other immunocytes may also contribute to HF IP maintenance in healthy human skin. Collapse of anagen hair bulb IP is an essential prerequisite for the development of alopecia areata (AA). In AA, lesional HFs are rapidly infiltrated by NKG2D + T cells and natural killer (NK) cells, while perifollicular mast cells acquire a profoundly pro‐inflammatory phenotype and interact with autoreactive CD8+ T cells. Using animal models, significant functional evidence has accumulated that demonstrates the dominance of the immune system in AA pathogenesis. Purified CD8+T‐cell and NK cell populations alone, which secrete fγ, suffice to induce the AA phenotype, while CD4+T‐cells aggravate it, and Tregs and iNKT cells may provide relative protection against AA development. While IP collapse may be induced by exogenous agents, inherent IP deficiencies might confer increased susceptibility to AA for some individuals. Thus, a key goal for effective AA management is the re‐establishment of a functional HF IP, which will also provide superior protection from disease relapse.

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Section: Therapeutic Perspectivesmentioning

confidence: 99%

Hair follicle immune privilege and its collapse in alopecia areata

Bertolini

McElwee

Gilhar

et al. 2020

Experimental Dermatology

166

157

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“…Jung et al 41 and Sotiriou et al 42 observed hair regrowth after topical tacrolimus 0.1% in 100% (3/3) and 44% (5/11) of children with alopecia areata, respectively. Conversely, a study performed by Price et al 43 revealed that topical tacrolimus 0.1% was ineffective in both, adults and children with alopecia areata.…”

Section: Resultsmentioning

confidence: 96%

“…The adverse effects of systemic JAK inhibitors in children with alopecia areata were diarrhoea, upper respiratory tract infection and headaches. [33][34][35] Topical Jung et al 41 and Sotiriou et al 42 observed hair regrowth after topical tacrolimus 0.1% in 100% (3/3) and 44% (5/11) of children with alopecia areata, respectively. Conversely, a study performed by Price et al 43 revealed that topical tacrolimus 0.1% was ineffective in both, adults and children with alopecia areata.…”

Section: Resultsmentioning

confidence: 99%

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Therapeutic management in paediatric alopecia areata: A systematic review

Waśkiel‐Burnat

Kołodziejak

Sikora

et al. 2021

Acad Dermatol Venereol

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Alopecia areata is the third most common cause of dermatology consultations in children but the treatment of paediatric alopecia areata remains challenging. A systematic review of the literature about the treatment of alopecia areata in children (≤18 years old) was performed on 11 May 2020 by searching the PubMed, Scopus and EBSCO databases.The terms used for the search were: 'alopecia areata', 'alopecia totalis' or 'alopecia universalis' combined with 'paediatric', 'children' or 'childhood'. A total of 89 articles were included in final evaluation. The most commonly assessed treatment options in paediatric alopecia areata were topical immunotherapy (response rate in monotherapy: 54%; 187/ 345) intralesional glucocorticosteroids (75%; 211/280), systemic glucocorticosteroids (73%; 102/140), and anthralin (42%; 31/74). Topical glucocorticosteroids (81%; 35/43), systemic Janus kinase (JAK) inhibitors (90%; 27/30), topical calcineurin inhibitors (42%; 8/19), topical JAK inhibitors (65%; 11/17), PUVA therapy (56%; 9/16) and 308-nm excimer laser (77%; 10/13) were also evaluated. Additionally, evaluation in smaller numbers of paediatric patients included methotrexate (100%; 10/10), topical minoxidil (44%; 4/9) and cyclosporine (83%; 5/6). There were limited data considering children with alopecia areata treated with azathioprine, hydroxychloroquine, topical sildenafil, topical prostaglandin analogues, fractional carbon dioxide laser, leflunomide, mesalazine, apremilast, dupilumab, ustekinumab, efalizumab, botulinum toxin, and compound glycyrrhizin. On the basis of the limited data available glucocorticosteroids (systemic, intralesional or topical) and JAK inhibitors (systemic or topical) may be considered the best documented and most effective treatment options in alopecia areata in children. There are no sufficient paediatric data to compare treatment safety and relapse rates in these therapeutic modalities.

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“…Based on previous successful animal studies, several clinical trials, mostly small case series, have been performed to assess the efficacy of tacrolimus ointment 2,3 or compare its efficacy with other topical agents, 4 when applied in a non-occlusive fashion both in early stage and longstanding recalcitrant AA. These studies failed to show terminal hair growth, which has been in large attributed to the high molecular weight of tacrolimus and the insufficient penetration depth of the ointment formulation in the presence of an intact epidermal barrier.…”

Section: Discussionmentioning

confidence: 99%

Occlusive treatment enhances efficacy of tacrolimus 0.1% in a pediatric patient with severe alopecia areata: Case report and literature review

Bimbi¹,

Kyriakou

Wollina

2020

Pediatric Dermatology

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Tacrolimus is an immunomodulatory drug, available for topical and systemic treatment of several dermopathies that are characterized by immune dysregulation. In the case of alopecia areata, standard application has proven insufficient to yield satisfactory results. Herein, we present a 6-year-old patient with Down syndrome who was treated with topical tacrolimus 0.1% ointment under occlusion overnight with remarkable clinical improvement within 4 months.

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Comparison of the topical FK506 and clobetasol propionate as first‐line therapy in the treatment of early alopecia areata

Cited by 12 publications

References 5 publications

Hair follicle immune privilege and its collapse in alopecia areata

Hair follicle immune privilege and its collapse in alopecia areata

Therapeutic management in paediatric alopecia areata: A systematic review

Occlusive treatment enhances efficacy of tacrolimus 0.1% in a pediatric patient with severe alopecia areata: Case report and literature review

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