026 Alopecia areata: Treatment today and tomorrow

Rolf Hoffmann, Dept. of Dermatology, Philipp University, Marburg, Germany

Alopecia areata is a tissue-restricted, T-cell mediated autoimmune disease of the hair follicle. Current treatments for alopecia areata involve immunosuppression by corticosteroids or PUVA. So far, attempts to treat alopecia areata with immunophilin-ligands such as FK506 or ASM981 have not been succesful. The most effective treatment for severe alopecia areata is the use of contact sensitizers such as diphenylcyclopropenone and squaric acid dibutylester. Although their mode of action is not precisely known, there is evidence that they mediate their beneficial effect in alopecia areata via the induction of the immunosuppressive cytokines TGF-ß and IL-10. Dictated by the autoimmune pathogenesis of AA, improved future treatments may be immunosuppressive, immunomodulatory, or protect the hair follicle from the injurious effects of the inflammation. As disease onset inhibitors are unlikely to be developed in the foreseeable future, research into new treatments must first focus on disease symptoms. Such possible future treatments are discussed, including the use of cyclosporine- or FK506-loaded liposomes, application of immunosuppressive cytokines like TGF-ß and IL-10, inhibition of apoptosis mediated by the Fas-FasL system, inhibition of the lymphocyte homing receptors CD44v10 or CD44v3, induction of tolerance with tolerogenic dendritic cells and gene therapy.