Case & reviewIs there a role for sulfasalazine in the treatment of alopecia areata?
Section snippets
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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Cited by (24)
Efficacy of mesalazine in children with moderate to severe alopecia areata: case series of 18 patients
2023, Anais Brasileiros de DermatologiaTreatment of pediatric alopecia areata: A systematic review
2022, Journal of the American Academy of DermatologyCitation Excerpt :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 DermatologiaCitation Excerpt :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 SurgeryTreatment Options for Alopecia Areata in Children and Adolescents
2024, Pediatric Drugs
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Conflicts of interest: None declared.