Ann Dermatol.  2008 Dec;20(4):172-178. 10.5021/ad.2008.20.4.172.

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

• Lee D
• Oh DJ
• Kim JW
• Park SW
• Oh MK
• Sung HS
• Hwang SW

• KMID: 2156388
• DOI: http://doi.org/10.5021/ad.2008.20.4.172

Abstract

BACKGROUND: Combination therapy using cyclosporine A (CsA) together with low-dose corticosteroids has adequate efficacy with little toxicity for the treatment of severe alopecia areata (AA).
OBJECTIVE
We wanted to evaluate the clinical efficacy of combination therapy using CsA with low-dose corticosteroid for the treatment of severe AA and we also wanted to determine the safe therapeutic concentration of CsA in the peripheral blood.
METHODS
We treated 34 cases of severe AA with combination therapy for 24 weeks and we evaluated the efficacy at 12 and 24 weeks. We monitored the peripheral blood concentration of CsA to determine the therapeutic range of CsA that has the fewest side effects.
RESULTS
Of the patients, 77.4% (n=24) and 22.6% (n=10) were classified in the responder and poor-responder groups, respectively. The mean trough concentration of CsA was 95.1 and 101.2 ng/ml in the responder and poor-responder groups, respectively. For the patients with side effects associated with CsA, the mean CsA concentration was 195.8 ng/ml.
CONCLUSION
We found that combination therapy with systemic CsA and low-dose corticosteroids effectively treats severe AA and this therapy results in a safe, therapeutic concentration of CsA in the peripheral blood.

Keyword

Alopecia areata; Cyclosporine A; Low-dose corticosteroids

MeSH Terms

Adrenal Cortex Hormones
Alopecia
Alopecia Areata
Cyclosporine
Humans
Adrenal Cortex Hormones
Cyclosporine

Figure

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  Fig. 1 (A) A 10-year-old boy with alopecia universalis before and after 24 weeks of treatment. (B) A 23-year-old women with alopecia universalis before and after 24 weeks of treatment. (C) A 35-year-old man with alopecia universalis before and after 24 weeks of treatment. (D) A 16-year-old women with alopecia areata affecting more than 75% of hair loss before and after 24 weeks of treatment.

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  Fig. 2 Trough concentration of cyclosporine A in the responders and poor-responders. The mean trough concentration of cyclosporine A in the responders was 94.2 ng/ml (range: 22.1~162.1 ng/ml) and 101.2 ng/ml (range: 39.2~178.4 ng/ml) in the poor-responders. The responders displayed a lower mean trough concentration than did the poor-responders (p<0.05).

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  Fig. 3 Trough concentration of cyclosporine A in the patients with and without side effects. In the group with side effects, the mean concentration of cyclosporine A was 195.8 ng/ml (34.8~381.2 ng/ml). The mean concentration of cyclosporine A in the patients without side effects was 91.2 ng/ml (22.1~204.8 ng/ml). The difference of the trough concentration of cyclosporine A between these two groups was significant (p<0.05).

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