ABSTRACT
Combination therapy with 5% minoxidil plus 0.5% anthralin was used to treat 51 patients with severe treatment-resistant alopecia areata. History of a cosmetically inadequate response to one or both drugs used as a single agent was present in 50 of the 51 patients. Therapy was relatively well tolerated except by 1 patient who developed a severe irritant reaction and was dropped from the study. Mild to moderate irritant dermatitis was seen in all remaining patients. Cosmetic response was seen in 5 (11%) of 45 patients who completed the 6-month study. Cosmetic response was maintained in 4 (80%) of 5 patients who continued treatment for as long as 84 weeks. All responders had evidence of hair regrowth by week 12. The rapidity and extent of hair regrowth were greater with combination therapy than with either drug used as a single agent. Serum and 24-hour urinary minoxidil determinations showed enhanced systemic minoxidil absorption, which was probably secondary to the irritant dermatitis in some patients; however, no clinical evidence of a systemic minoxidil effect was found. These data suggest that combination therapy using drugs with probable different mechanisms of action may provide a synergistic effect in alopecia areata.
Subject(s)
Alopecia Areata/drug therapy , Anthralin/therapeutic use , Minoxidil/therapeutic use , Administration, Topical , Adolescent , Adult , Anthralin/administration & dosage , Anthralin/adverse effects , Child , Drug Combinations , Drug Eruptions/etiology , Female , Hair/drug effects , Hair/growth & development , Humans , Irritants , Male , Middle Aged , Minoxidil/administration & dosage , Minoxidil/adverse effects , Minoxidil/pharmacokinetics , Remission Induction , Time FactorsABSTRACT
A dose-response effect has previously been demonstrated in topical minoxidil treatment of alopecia areata. Limitations in minoxidil solubility and percutaneous absorption have impaired the development of more effective topical therapy. Oral minoxidil (5 mg every 12 hours), a dose demonstrated to be relatively well tolerated if a 2-g sodium diet is strictly followed, was given to 65 patients with severe, treatment-resistant alopecia areata in an attempt to bypass the limitations of topical treatment and increase efficacy. Although hair regrowth progressed more rapidly and was more extensive with oral than topical 5% minoxidil, cosmetic response was seen only in 18% of the patients. Neither serum nor tissue levels of minoxidil correlated with response. These findings suggest that improved preparations of topical minoxidil, when used as a single therapeutic agent, are unlikely to be cosmetically effective in the majority of patients with severe alopecia areata.