Anita Tarajkowska – Olejnik, Monika Słowińska, Lidia Rudnicka

Dept. of Dermatology, CSK MSW iA Warsaw, Poland

Cyclosporine A (CsA) is an immunosuppresive drug which is widely used in T- cell mediated skin diseases. It inhibits IL – 2 transcription’s mediating enzyme – calcineurine, leading to decrease secretion of IF g involved in pathogenesis of  alopecia areata (AA). Several data indicate that a  decrease in immune cell infiltration of hair follicles after CsA treatment correlates with clinical improvement. The aim of the study was to evaluate the efficacy of CsA in a different subtypes of AA  depending on disease duration and intensification.The evaluation was performed in 17 patients with multiple patchy AA (including 6 with total AA, 2 with ophiasic AA) with history of AA between 1,5 and 25 years. The patient’s ages ranged from 18 to 55. Patients with serious medical history such as hypertension, cardiac failure, nephropathy or chronic infections were excluded. An oral dose of 100 mg of CsA per day was administered (1.5 –2.0 mg/kg/ daily ) without any topical concomitant treatment. The efficacy of treatment was evaluated by clinical examination, photodocumentation and individual patient’s satisfaction sheet in 1-month intervals. Hair regrowth - 15 patients after an average period of 3,5 months. Cosmetically acceptable improvement appeared after an average of 3,4 months of therapy with a patchy AA, after 8 months in AA totalis and in 7 ophiasis. 1 patient with total AA (16,6%) developed recurrent hair loss despite of continuing treatment after 3 years of therapy. In 2 patients partial hair loss was observed upon CyA dose reduction after 1,5 years. 2 patients with ophiasis type of AA never developed regrowth of the hair up to 1,5 year long observation. All patients with patchy AA showed full hair regrowth with no signs of regression after treatment was discontinued. Laboratory tests included blood count, potassium level, nitrogen, aminotransferases, urea, creatinine and urine analysis were within normal range. 1 patient developed drug–controlled hypertension, 1 – intermittent   trembling and 1 – mild folliculitis. In conclusion, our results indicate that low-dose CsA is a valuable and relatively safe method of therapy in patchy AA, whereas patients with total AA and ophiasis AA show less beneficial response to treatment.