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Patients with alopecia treated with whole-body PUVA and corticosteroids experienced hair regrowth.

Hair loss in alopecia areata is associated with an inflammatory infiltrate of lymphocytes, suggesting an autoimmune cause. In search of a safe and effective treatment option for this condition, researchers enrolled nine patients in a trial of oral psoralen and ultraviolet A (PUVA) therapy plus oral prednisolone for alopecia areata. Six patients had alopecia totalis, and three had alopecia universalis. All patients had been treated with topical squaric acid dibutylester, oral prednisolone (20 mg/day), or cyclosporin A (3 mg/kg/day) for at least 6 months without "satisfactory results." Three patients with alopecia totalis undergoing treatment with prednisolone 20 mg/day served as controls.

The treatment group received 20 mg of methoxsalen, followed 2 hours later by total-body irradiation with ultraviolet A light (UVA) in increasing doses 5 days each week for 4 weeks. The maximum UVA dose was 80 J/cm². These patients also received oral prednisolone (20 mg/day for 4 weeks, gradually tapered to zero during the following 3 months). Evaluation was made by paired comparison of pre- and posttreatment photographs graded on a global assessment scale (0–3; 0 = no hair growth, 3 = greatly increased growth).

At 3 months, seven patients had greatly increased terminal hair growth (score, 3) on the whole scalp, and the remaining two (both with alopecia universalis) had moderately increased hair growth (score, 2). The control group had significantly lower scores (P<0.01). Hair was maintained in all but two patients, both of whom relapsed 6 months after treatments were stopped.

Comment: It is worth noting that unlike the other patients, one received irradiation of the body but not the scalp; this patient also had hair regrowth, suggesting a systemic effect. The authors present some data to suggest that T regulatory cell (Treg) function is restored by the treatment, contributing to regrowth. All patients also received prednisolone, and the study does not help us know if whole-body PUVA would work without it.

— Mark V. Dahl, MD

Published in Journal Watch Dermatology July 24, 2009

Citation(s):

Ito T et al. Combination therapy with oral PUVA and corticosteroid for recalcitrant alopecia areata. Arch Dermatol Res 2009 Jun; 301:373.

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Review and add to remarks on this article

• Alopecia Hair regrowth
  Chloe L. Brown, n/a, 29 Jul 2009 2:53 PM EST
  What were the ages of the patients? Would the treatment be safe for cardiac patients on various drugs? Coumadin, Plavix,... [more]
• LONG TERM OF SYSTEMIC STEROIDS
  DR SALVATORY LEUNCE NTUBIKA, TANZANIA, 12 Aug 2009 4:53 PM EST
  I AM WORRIED THE WRONG TERM OF SYSTEMIC STEROIDS ALTHOUGH IT WAS GIVEN IN LOW DOSE OF 20mg/day instead of... [more]

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