Which medications in the drug class Immunomodulators are used in the treatment of Alopecia Areata?

Updated: Aug 06, 2020
  • Author: Chantal Bolduc, MD, FRCPC; Chief Editor: Dirk M Elston, MD  more...
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Because alopecia areata is believed to be an autoimmune condition, different immunomodulators have been used to treat the condition. Exact mechanism of action of topical immunotherapy is unknown. Antigenic competition was hypothesized (ie, introduction of a second antigen can initiate a new infiltrate containing T-suppressor cells and suppressor macrophages that may modify preexisting infiltrate and allow regrowth).

Commonly used agents for immunotherapy include SADBE and DPCP. These are compounded investigational agents not approved by the US Food and Drug Administration for use in alopecia.

Cyclosporine (Sandimmune, Neoral)

Cyclosporine is used both topically and systemically for the treatment of alopecia areata. Topical cyclosporine has shown limited efficacy. Although systemic CsA appears to be effective in alopecia areata, the adverse effect profile, recurrence rate after treatment discontinuation, and inability to produce long-term remissions make CsA unattractive for the treatment of alopecia areata. The mechanism by which cyclosporine stimulates hair growth remains unknown. It may act through its immunosuppressive effect because patients who regrew hair had clearance of immune cells from the hair follicles and alteration in the balance of regulatory lymphocytes (ie, decreased CD4/CD8 ratio). Cyclosporine causes hypertrichosis in patients treated for conditions unrelated to hair loss.

Methoxsalen (8-MOP, Oxsoralen)

Methoxsalen inhibits mitosis by binding covalently to pyrimidine bases in DNA when photoactivated by UV-A.

Anthralin (Dritho-Scalp 0.5% cream, Anthra-Derm 1% cream, Drithocreme 1%, Micanol 1% cream)

Anthralin is a synthetic derivative of a tree bark extract. Its mechanism of action in alopecia areata is unknown. Most likely, it creates inflammation by generating free radicals, which have antiproliferative and immunosuppressive actions. Both short-contact and overnight treatments have been used. High concentration (1-3%) is used for short-contact treatments. Lower concentrations (0.1-0.4%) are used for overnight treatments. Applications in excessive amounts may stain clothing.

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