tacrolimus and Alopecia-Areata

Tacrolimus is an immunomodulatory drug, available for topical and systemic treatment of several dermopathies that are characterized by immune dysregulation. In the case of alopecia areata, standard application has proven insufficient to yield satisfactory results. Herein, we present a 6-year-old patient with Down syndrome who was treated with topical tacrolimus 0.1% ointment under occlusion overnight with remarkable clinical improvement within 4 months.

Topics: Administration, Cutaneous; Administration, Topical; Alopecia Areata; Child; Humans; Tacrolimus; Treatment Outcome

Alopecia areata is a common disease, but for ethical reasons it seems difficult to perform large-scale studies to elucidate the pathogenesis and to develop new therapeutic approaches in man. It is therefore helpful to develop appropriate animal models. The Dundee experimental bald rat (DEBR) and the C3H/HeJ mouse are well-established animal models for alopecia areata and can be used for the study of genetic aspects, pathogenesis and therapy of the disease. In C3H/HeJ mice alopecia areata can be experimentally induced by grafting lesional skin from an affected mouse to a histocompatible recipient which offers the possibility to study the influence of various factors on the development of the disease. Studies on the C3H/HeJ mouse and the DEBR have corroborated the concept that alopecia areata is a T-cell mediated autoimmune disease and various steps and aspects of the pathogenesis have been elucidated. Based on this knowledge new therapeutic options may be developed such as inhibition of lymphocyte-homing by an anti-CD44v10 antibody, or inhibition of costimulation by monoclonal antibodies. Therapeutic studies in the C3H/HeJ mouse and the DEBR suggest that alopecia areata can be treated by topical tacrolimus but treatment in humans may only be successful after development of an improved vehicle that facilitates penetration of tacrolimus down to the hair bulb. Current investigations in mice are designed to elucidate the mechanisms how contact sensitizers act in the treatment of alopecia areata, and this will hopefully lead to the development of more specific approaches based on the beneficial effect of contact sensitizers.

Topics: Alopecia Areata; Animals; Autoimmune Diseases; Disease Models, Animal; Immunosuppressive Agents; Immunotherapy; Mice; Mice, Inbred C3H; Models, Immunological; Rats; Species Specificity; T-Lymphocytes; Tacrolimus; Treatment Outcome

Alopecia areata is considered to be a T-cell mediated autoimmune disease of the hair follicle. Current immunosuppressive approaches and immunomodulatory treatment with contact sensitizers such as diphenylcyclopropenone and squaric acid dibutylester are dealt with in this review article. The efficacy of the various modes of treatment is evaluated by a review of literature and their mode of action is discussed. In accordance with the mechanism of autoimmune pathogenesis of AA, improved future treatments may be immunosuppressive or immunomodulatory, or they should otherwise protect the hair follicle from the injurious effects of the inflammation. Such possible future therapeutic approaches include the use of liposomes as an improved vehicle, application of immunosuppressive cytokines like TGF-beta and IL-10, inhibition of apoptosis mediated by the Fas-FasL system, inhibition of the lymphocyte homing receptor CD44v10, induction of tolerance as well as principles of gene therapy.

Topics: Adjuvants, Immunologic; Adrenal Cortex Hormones; Alopecia Areata; Animals; Autoimmune Diseases; Female; Hair Follicle; Haptens; Humans; Immunosuppressive Agents; Male; PUVA Therapy; Tacrolimus

Alopecia areata (AA) is a common non-scarring hair loss disorder that affects children and adults with a great psychological burden because of its recurrent and sometimes treatment-refractory nature.. To compare the efficacy of topical calcineurin inhibitor, topical potent steroid combined with vitamin D analogue versus topical superpotent steroid in treatment of localized AA.. Sixty subjects with chronic (>1 year) localized (SALT score < 25%) AA, confirmed clinically and dermoscopically, were randomized into three groups. Group I used topical 0.03% tacrolimus (Tarolimus®), group II used topical potent steroid combined with vitamin D analogue (Daivobet®). and group III used topical superpotent steroid (Dermovate®). All patients continued a daily therapy for three successive months and were followed up for three other months. Assessment was done using PULL test, SALT score, and dermoscopic comparison before and after therapy.. Group II showed comparable statistical results to group III with lower values in a non-statistically significant way. Group I achieved the least improvement among all groups.. Combined vitamin D analogues with potent steroid appears to be a more convenient treatment for localized AA than superpotent steroids because of less side effects and comparable efficacy. Tacrolimus needs further research or formula customization to be used as a topical therapy for AA.

Topics: Adult; Alopecia Areata; Child; Clobetasol; Humans; Tacrolimus; Treatment Outcome; Vitamin D

Alopecia areata (AA) is a non-scarring hair loss.. We aimed the comparison of clobetasol propionate and pimecrolimus efficiency and tolerability in the treatment of AA.. The study included a total of 100 consecutive patients with AA. Patients were randomized into four groups. 30 patients used 1% pimecrolimus cream, 30 patients used 0.05% clobetasol propionate cream, 20 patients used petrolatum as placebo. Scalp of 20 patients was divided into two equal areas and one area was treated with 1% pimecrolimus cream and the other area with 0.05% clobetasol propionate cream.. At week 12 of treatment, the recovery rate of the pimecrolimus group was 53.73 ± 44.49 and the recovery score was 3.63 ± 2.07; that of the clobetasol propionate group was 47.00 ± 44.80 and the recovery score was 3.33 ± 2.20; that of the placebo group was 35.50 ± 40.53 and the recovery score was 2.75 ± 1.88. There was no statistically significant difference among the groups in terms of the percentage of recovery and the recovery score (p < 0.05).. In conclusion, we detected that topical pimecrolimus treatment is as effective as topical corticosteroids and is superior to topical corticosteroids in terms of side effects in the treatment of AA.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Alopecia Areata; Anti-Inflammatory Agents, Non-Steroidal; Child; Child, Preschool; Clobetasol; Dermatologic Agents; Female; Glucocorticoids; Humans; Male; Middle Aged; Petrolatum; Tacrolimus; Young Adult

To evaluate the efficacy of two topically applied immunomodulative agents through the detection of lymphocyte subsets using monoclonal antibodies against CD4, CD8 and MHC II.. Fifty patients from the Departments of Medical Biochemistry, Dermatology and Pathology at Cairo University with different degrees of alopecia areata (AA) were included in this study. They were classified into two groups each of 25 patients. Each patient was treated with the immunomodulative agent on one side of the scalp and the other side was left as a control. Biopsies were taken from all patients at the beginning of treatment and at the end of the study. Tissue specimens were prepared for histologic and immunophenotypic analysis. The main outcome measures were the uses of diphencyprone (DPCP) and topical tacrolimus as two topical immunotherapeutic modalities in the treatment of AA.. A clinical response of 68% was achieved in group A (treated with DPCP) while group B (treated with 0.1% tacrolimus) showed an insignificant clinical response. Decreased expression of CD4 and increased expression of CD8 and MHC II was detected in the post-treated areas compared with pretreated areas in cases treated with DCPC. In tacrolimus-treated cases, there was a decrease in CD4 and MHC II, with no change in CD8 between the pre- and post-treated areas.. DCPC is one of the most accepted therapeutic modalities in the treatment of AA, with a favourable prognosis among patchy hair loss. MHC II expression was the one correlating with clinical response. Tacrolimus, though beneficial in other dermatoses, could not be considered effective in the treatment of AA.

Topics: Administration, Topical; Adolescent; Adult; Alopecia Areata; Antibodies, Monoclonal; Biomarkers; CD4 Antigens; CD8 Antigens; Child; Cyclopropanes; Egypt; Female; Histocompatibility Antigens Class II; Humans; Immunohistochemistry; Immunosuppressive Agents; Male; Scalp Dermatoses; T-Lymphocyte Subsets; Tacrolimus; Treatment Outcome; Young Adult

Topics: Adolescent; Adult; Alopecia Areata; Dermatologic Agents; Emollients; Humans; Immunosuppressive Agents; Pilot Projects; Tacrolimus

Eleven patients with alopecia areata affecting 10% to 75% of the scalp, average duration 6 years, had no terminal hair growth in response to tacrolimus ointment 0.1% applied twice daily for 24 weeks. Treatment failure may reflect insufficient depth of penetration of the ointment formulation and less than optimal patient selection.

Topics: Administration, Topical; Adolescent; Adult; Alopecia Areata; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Tacrolimus

Topics: Administration, Cutaneous; Adolescent; Adult; Alopecia Areata; Anti-Inflammatory Agents; Child; Clobetasol; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Tacrolimus

Topics: Acute Disease; Administration, Oral; Aged; Alopecia Areata; Arthritis, Rheumatoid; Female; Hair; Humans; Immunosuppressive Agents; Tacrolimus

Leukotrichia can be caused by a variety of metabolic and inflammatory diseases. Canine alopecia areata is a rare multifactorial benign non-scarring alopecia. This case report describes a seasonally recurrent leukotrichia associated with alopecia areata in a German shepherd dog. Important differential diagnoses were ruled out and histopathology finally confirmed the diagnosis of alopecia areata. Topical tacrolimus and hydrocortisone aceponate were ineffective. The cause for the seasonal character in this case remained undetermined.

Topics: Administration, Topical; Alopecia Areata; Animals; Biopsy; Diagnosis, Differential; Dog Diseases; Dogs; Hypotrichosis; Immunohistochemistry; Immunosuppressive Agents; Male; Recurrence; Seasons; Skin; Tacrolimus

Alopecia Areata (AA) is a non-scarring alopecia that affects millions of Americans, however the way it is treated and which patients seek treatment is not well characterized.. To better understand how AA was being treated in the United States, what type of patients are seen for AA, and what physicians treated them.. We analyzed data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2001 to 2010. We tabulated patient characteristics, the physicians who treated AA and what treatments were prescribed for AA.. There were an estimated 2.6 million outpatient visits for AA. Patients with AA were most commonly treated by a dermatologists (84.8%). Patients were most commonly treated with topical and injected corticosteroids (61.0%) followed by minoxidil (5.9%) and topical tacrolimus (5.7%). Males made fewer visits per 1,000 capita compared to females (P=0.01).. The NAMCS and NHAMCS do not record severity of disease data.. Topical and injected corticosteroids are the mainstay of treatment for AA, however the use of steroid sparing agents such as minoxidil is low. Despite no studies demonstrating efficacy, topical tacrolimus was used almost as frequently as minoxidil.

Topics: Administration, Cutaneous; Adolescent; Adrenal Cortex Hormones; Adult; Alopecia Areata; Black or African American; Calcineurin Inhibitors; Cross-Sectional Studies; Dermatology; Female; Health Care Surveys; Humans; Injections; Male; Minoxidil; Office Visits; Retrospective Studies; Sex Factors; Tacrolimus; United States; Vasodilator Agents; White People

Topics: Administration, Topical; Adolescent; Alopecia; Alopecia Areata; Child; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Infusions, Intravenous; Methylprednisolone; Phobic Disorders; Psychophysiologic Disorders; Tacrolimus

Alopecia areata is an autoimmune disorder characterized by the sudden development of a circumscribed patch of non-scarring hair loss on the scalp or any hair-bearing surface.The presentation of this disorder can be hair loss in a single circumscribed patch, complete loss of hair on the scalp (alopecia totalis) or complete loss of hair on the entire body (alopecia universalis). The following cases involve two patients with treatment-refractory alopecias that benefited significantly after treatment with a combination of ezetimibe and simvastatin, in addition to the continuation of intra-lesional corticosteroid injections. In this report, the known immunomodulatory effects of statins in combination with ezetimibe are discussed along with the known histopathologic findings of autoimmune alopecia. Major histocompatibility complex class II (MHC-II) and intracellular adhesion molecule-1 (ICAM-1) appear to be involved in both the immunomodulatory effects of statins and the pathophysiology of autoimmune alopecia.

Topics: Adrenal Cortex Hormones; Adult; Alopecia Areata; Anticholesteremic Agents; Drug Therapy, Combination; Female; Hair; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Immunosuppressive Agents; Minoxidil; Scalp; Simvastatin; Tacrolimus

Although clinical trials for new drugs are often limited in children because of safety concerns or restrictions, new therapies or novel strategies with old drugs have recently expanded dermatologic armamentarium for pediatric patients. Oral propranolol is currently the first choice in the treatment of alarming infantile hemangiomas. In atopic dermatitis, proactive strategy with topical calcineurin inhibitors can safely prevent disease exacerbation. Tacrolimus, in particular, is also useful for the treatment of vitiligo occurring in sensitive areas such as the eyelids. Among biologic drugs, use of etanercept is safe and efficient in children and adolescents with moderate-to-severe plaque psoriasis. Engineered tissues with special antimicrobial properties (silver-coated fabrics or engineered silk) are now used to treat eczema and fungal diseases in children. In athlete's foot, the use of 5-finger socks can also be helpful.

Topics: Adolescent; Adrenal Cortex Hormones; Alopecia Areata; Autoimmune Diseases; Child; Child, Preschool; Dermatitis, Atopic; Eczema; Female; Hemangioma; Humans; Immunosuppressive Agents; Male; Propranolol; Psoriasis; Randomized Controlled Trials as Topic; Skin Diseases; Tacrolimus; Therapies, Investigational; Vitiligo

Tacrolimus is an immunosuppressive agent used in solid organ and islet transplantation. Its topical form has shown benefit in the treatment of inflammatory skin conditions. Although tacrolimus has a wide spectrum of side effects, dermatological complications related to systemic tacrolimus therapy are limited in the literature. Atopic dermatitis (AD) is a chronic pruritic cutaneous condition that usually begins in infancy and is characterized by an increased Th2 response. We report the case of a patient with type 1 diabetes mellitus (T1DM) and history of AD latent for 10 years who developed severe dermatitis and alopecia 5 months after undergoing allogeneic islet transplantation and initiating a steroid-free immunosuppressive regimen with sirolimus and tacrolimus maintenance. After exclusion of other possible causes for the progression and exacerbation of the clinical presentation of AD, discontinuation of tacrolimus and introduction of mycophenolate mofetil resulted in full remission of the symptoms. The beneficial effects of tacrolimus withdrawal suggest a cause-effect relationship between this adverse event and the utilization of the drug. Islet graft function remained stable after modification of the therapeutic regimen (stable glycemic control and unchanged C-peptide).

Topics: Adult; Alopecia Areata; Dermatitis, Atopic; Diabetes Mellitus, Type 1; Female; Humans; Immunosuppressive Agents; Islets of Langerhans Transplantation; Tacrolimus; Transplantation, Homologous; Treatment Outcome

Topics: Adult; Alopecia Areata; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Tacrolimus; Treatment Failure

Topics: Administration, Topical; Alopecia Areata; Child; Humans; Immunosuppressive Agents; Male; Tacrolimus; Treatment Failure

We elected to examine the efficacy of the topically applied immunosuppressive agent FK506 (Prograf) in the treatment of alopecia areata (AA) using the Dundee experimental bald rat (DEBR) model. Thirty lesional DEBR rats were allocated to five groups of six. Group 1 rats received 0.1 mL of a 0.25% solution of FK506 within a 2 x 2 cm marked area on one bald flank twice a week (125 micrograms FK506/cm2 per week) for 8 weeks, while the contralateral flank was left untreated. In group II, 0.05 mL of a 0.1% solution of FK 506 was applied 5 days per week on one flank (62.5 micrograms FK506/ cm2 per week) and control vehicle to the opposite flank for 8 weeks. Group III rats were treated as in group II except that drug and vehicle were applied twice a week (25 micrograms FK506/cm2 per week) for 4 weeks. A positive control group received orally administered cyclosporin A (CsA) (10 mg/kg daily) for 8 weeks and a further group was left untreated. Rats were regularly examined and photographed with skin biopsies taken from groups II and III. All FK 506-treated rats regrew hair at the site of drug application within 14-21 days. Growth continued for 3 weeks beyond termination of treatment after which gradual hair loss was observed. No hair growth was seen as a result of vehicle application and hair loss continued on untreated areas and in the untreated control group. Immunohistology revealed a drastic reduction in the follicular inflammatory infiltrate at the site of the FK506 application. The oral CsA group responded by simultaneous regrowth of hair over the whole body. Our findings suggest that FK506 may have considerable potential as a topical treatment for AA.

Topics: Alopecia Areata; Animals; Cyclosporine; Disease Models, Animal; Female; Hair; Hair Follicle; Immunoenzyme Techniques; Immunosuppressive Agents; Male; Rats; Rats, Inbred Strains; Tacrolimus

Topics: Alopecia Areata; Animals; Cyclosporine; Hair; Kidney; Rats; Rats, Inbred Strains; Skin; Tacrolimus