Case & review
Is there a role for sulfasalazine in the treatment of alopecia areata?

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Promising results have been published in the past with the use of sulfasalazine in alopecia areata. We also observed maintenance of hair growth in refractory alopecia areata patients who were treated with sulfasalazine in combination with oral corticosteroids for 2 to 6 months and sulfasalazine alone for 4 to 12 months while steroids were being tapered. We believe that, because of the small series reported herein, additional larger prospective studies should be conducted to validate these results.

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Case 1

A 33-year-old woman had a 5-year history of progressive patchy hair loss involving 30% of occipital and left parietal scalp hair. She had a partial response to topical anthralin, oral steroids, and systemic steroid injections at different time intervals, but reshedding of new grown hairs was inevitable. The patient began oral sulfasalazine (1 g/d with 500-mg/wk increments, with a final dosage of 3 g/d) along with oral methylprednisolone (1 mg/kg/d). Complete recovery was seen after 3 months and

Discussion

AA has an unpredictable outcome. In the majority of patients, hair will regrow entirely within 1 year without treatment. However, 7% to 10% of patients can eventually develop the severe chronic form of the condition, which is refractory to most treatments.25

The final outcome of the alopecic areas was 50% to 100% improvement; it was more than 50% in 3 of our 6 patients. Growth of new hairs could be sustained in all. Since sulfasalazine is regarded as a comparatively safe drug,26, 27 no

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    • Treatment of pediatric alopecia areata: A systematic review

      2022, Journal of the American Academy of Dermatology
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      Complete response to mesalazine, with or without concurrent oral or topical corticosteroids and minoxidil, was reported in 1 case series of 5 pediatric patients.89 Ten adolescent AA patients treated with oral sulfasalazine in 2 studies all demonstrated partial response with a starting dose of 1 g/week, which was escalated to a final dose of 3 g/week.90,91 Side effects for sulfasalazine included dizziness, headache, and dyspepsia (Table II).

    • Consensus on the treatment of alopecia areata – Brazilian Society of Dermatology

      2020, Anais Brasileiros de Dermatologia
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      An uncontrolled open study demonstrated rates of hair regrowth with sulfasalazine (1.5 g 2 ×/day) between 25% and 68% in patients with refractory AA, alone or in combination with CT therapy, acting as a CT-sparing agent. However, the side effect profile remains a limiting factor.72 Recently, hair regrowth was reported with the use of mesalazine (15−30 mg/kg/day in two daily doses) associated or unassociated with topical oral CT or minoxidil/betamethasone in the treatment of five children and adolescents (2–17 years) with refractory and severe AA.73

    • Alopecia Areata: Evidence-Based Treatments

      2009, Seminars in Cutaneous Medicine and Surgery
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    Funding sources: None.

    Conflicts of interest: None declared.

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