Azathioprine for the Treatment of Extensive Forms of Alopecia Areata: A Systematic Review

The systematic review evaluated the efficacy and safety of azathioprine for treating severe forms of alopecia areata (AA). Seven articles were reviewed, covering various clinical variants of AA. Azathioprine doses ranged from 2 to 2.5 mg/kg/day or weekly 5 mg/kg pulse therapy, with initial responses observed between 6 to 12 weeks and near-complete resolution by 32 weeks. The response was sustained for 6 months after discontinuation, with a 14% relapse rate at 2.5 months. Adverse effects included gastrointestinal discomfort, elevated liver function tests, and myelosuppression. The review concluded that azathioprine showed promise for treating extensive AA, but randomized-controlled trials were necessary to confirm its efficacy.