Topical corticosteroid creams are used for alopecia areata

Alopecia areata hair loss information for men and women
Alopecia Areata 
Alopecia Areata Biology
Alopecia Areata Treatments

  Topical Corticosteroids for Alopecia Areata
 

Alopecia areata is an erratic hair loss disease, which either produces bald patches, or in a more extensive form, total hair loss. Although it is not a life threatening disease and regrowth of hair occurs almost certainly, men and women afflicted by the disease often go through socio-psychological trauma because of the disfigurement caused. No complex cure for alopecia areata has yet been discovered and all medical intervention attempts only in suppressing the disease and promoting hair growth.

Effect of Corticosteroids in Alopecia Areata

Alopecia areata has been identified as an autoimmune disease. Hence, the therapy used in the control of the disease is largely immunomodulatory in nature. Corticosteroids are a popular choice in the treatment of this disease as they inhibit the activation of T-lymphocytes. As alopecia areata is believed to be a T-cell mediated response, restricting the T-cells plays a significant role in controlling the disease. Besides, corticosteroids are easy to administer and reduces any pain or inflammation associated with the condition. They can be applied topically, injected systemically and locally into the lesions or taken orally. Each of these methods has a varying degree of potency, depending on the extent of the disease, and different side effects.

Topical corticosteroids are the mildest form of steroid treatment. Several topical creams are available commercially with different concentrations of steroids. The mildest form of steroids is always chosen as the first line of treatment of alopecia areata by dermatologists. For effective treatment with topical corticosteroids, the drug has to be applied to penetrate the stratum, conium, epidermis and dermis to the subcutaneous fatty layer. Insufficient penetration of the drug dissolved in cream or lotion has often led to a failure in treatment with topical corticosteroids.

Success Rate of Topical Corticosteroids

Extensive studies have been carried out with corticosteroids by different teams. There has been a mixed response to the drug in all the clinical trials. A trial with 0.2% fluocinodole acetonide conducted on 28 patients for 6 months showed excellent to satisfactory results on 17 patients. It was observed that the success of the drug depended not so much on the extent of the disease than on the age of the patient and the duration of the condition. Almost 100% success was evident in children between 3 to 10 years of age as compared to 50% in older children and only 33% in adults. Even diseases, which have been present for a longer time, showed improvement in the case of children. Generally, good success rate was observed in cases where the disease was less than a year old.

Treatment with 60gm of 0.1% haliconide applied daily, was conducted for a period of 6 to 18 months on patients with patchy as well as extensive hair loss. Regrowth of hair was observed in all cases. However, biopsies conducted on four patients revealed that despite the hair growth, the drug did not cause any reduction of the inflammatory infiltrate seen before treatment.

Studies were also conducted with 0.05% betamethasone dipropionate cream applied to both children and adults. Results were only evident after three months of continuous application. However, this treatment could prove effective in patients with active recurrent alopecia areata.

A comparative study was made with a review of 277 patients with alopecia areata, treated with topical steroids, over a 10-year period. Regrowth ranging from 50-100%was seen in most of the patients. The results were almost similar to that in 72 patients treated with tapering doses of oral prednisone for 6 to 8 weeks.

It is presumed that topical steroids induce hair growth in humans by suppressing the local autoimmune factors that restrict hair growth. But it has been observed that topical corticosteroids have quite the reverse effect on mice and inhibit hair growth in them. Stern et al have proposed that corticosteroids do not affect the signals that initiate the hair forming genes but they block the expression of the genes. It is to be noted that mice have synchronous anagen where whole groups of hair follicles enter the catagen or the anagen phase together. Therefore, the exact association between the two remains unclear.

Precautions and Side Effects of topical Corticosteroids

It is important to use topical corticosteroids in sufficiently potent doses to control the disease without, at the same time, manifestations of local or systemic side effects. The effective minimum and maximum doses remain to be determined. But widespread misuse has led in some cases to undesirable side effects. Careful consideration must be given to the risks and benefits associated with topical corticosteroids before implementing a treatment programme, especially, one requiring long term usage. The typical side effects of topical corticosteroids include:

  • Folliculitis or inflammation of the hair follicles
  • Hypertrichosis or excessive hair growth in different parts of the body
  • Acneform eruption
  • Local atrophy or chronic dilation of capillaries leading to red blotchy patches

Before being used in the periocular region, a preliminary eye examination or regular follow up examinations must be done for glaucoma and cataract. Children requiring high doses of class I or class II topical corticosteroids need to be monitored to control systemic side effects.

It must be noted that no real comparison is possible between treatment of alopecia areata with topical corticosteroids and other modes of treatment. The absolute matching of age groups with similar extent and duration of the disease in the different trials is not possible. Also, the parameters that define satisfactory hair regrowth vary from person to person.

Conclusion

Alopecia areata is a T-cell mediated autoimmune skin disease that is pathologically very similar to other immune mediated inflammatory diseases like psoriasis and atopic dermatitis. Therapies for psoriasis are therefore now being explored for treatment of alopecia areata too. Topical immunumodulators that act locally on T-cells by suppressing cytokine transcription are now being clinically tried and we can hope that there will be further progress in the use of topical corticosteroids in the therapy of alopecia areata.



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