Efficacy of topical cyclosporin a in the treatment of alopecia areata

Cyclosporin A-loaded poly(d,l-lactide) nanoparticles: a promising tool for treating alopecia

Background: Alopecia treatments are scarce and lack efficacy. Cyclosporin A (CsA) has hair growth-inducing properties but its poor cutaneous absorption undermines its use in topical treatments. Aim: Development of a new potential topical treatment of alopecia with CsA. Materials & methods: CsA-loaded poly(d,l-lactide) (PLA) nanoparticles were obtained and characterized. Skin permeation was evaluated in ex vivo porcine skin. Results: Nanoparticles with good physicochemical stability increased CsA skin permeation/hair follicles accumulation, compared with a noncolloidal formulation. CsA biocompatibility in NCTC2455 keratinocytes (reference skin cell line) was clearly improved when encapsulated in PLA nanoparticles. Conclusion: This work fosters further in vivo investigation of CsA-loaded PLA nanoparticles as a promising new strategy to treat alopecia, a very traumatic, possibly autoimmune, disease.

Interventions for alopecia areata

BACKGROUND

Alopecia areata is a disorder in which there is loss of hair causing patches of baldness but with no scarring of the affected area. It can affect the entire scalp (alopecia totalis) or cause loss of all body hair (alopecia universalis). It is a relatively common condition affecting 0.15% of the population. Although in many cases it can be a self-limiting condition, nevertheless hair loss can often have a severe social and emotional impact.

OBJECTIVES

To assess the effects of interventions used in the management of alopecia areata, alopecia totalis and alopecia universalis.

SEARCH STRATEGY

We searched the Cochrane Skin Group Specialised Register in February 2006, the Cochrane Central Register of Controlled Clinical Trials (The Cochrane Library Issue 1, 2006), MEDLINE (from 2003 to February 2006), EMBASE (from 2005 to February 2006), PsycINFO (from 1806 to February 2006), AMED (Allied and Complementary Medicine, from 1985 to February 2006), LILACS (Latin American and Caribbean Health Science Information database, from 1982 to February 2006), and reference lists of articles. We also searched online trials registries for ongoing trials.

SELECTION CRITERIA

Randomised controlled trials that evaluated the effectiveness of both topical and systemic interventions for alopecia areata, alopecia totalis, and alopecia universalis.

DATA COLLECTION AND ANALYSIS

Two authors assessed trial quality and extracted the data. We contacted trial authors for more information. We collected adverse effects information from the included trials.

MAIN RESULTS

Seventeen trials were included with a total of 540 participants. Each trial included from 6 to 85 participants and they assessed a range of interventions that included topical and oral corticosteroids, topical ciclosporin, photodynamic therapy and topical minoxidil. Overall, none of the interventions showed significant treatment benefit in terms of hair growth when compared with placebo. We did not find any studies where the participants self-assessed their hair growth or quality of life.

AUTHORS' CONCLUSIONS

Few treatments for alopecia areata have been well evaluated in randomised trials. We found no RCTs on the use of diphencyprone, dinitrochlorobenzene, intralesional corticosteroids or dithranol although they are commonly used for the treatment of alopecia areata. Similarly although topical steroids and minoxidil are widely prescribed and appear to be safe, there is no convincing evidence that they are beneficial in the long-term. Most trials have been reported poorly and are so small that any important clinical benefits are inconclusive. There is a desperate need for large well conducted studies that evaluate long-term effects of therapies on quality of life. Considering the possibility of spontaneous remission especially for those in the early stages of the disease, the options of not being treated therapeutically or, depending on individual preference wearing a wig may be alternative ways of dealing with this condition.