Combination Therapy with Cyclosporine and Psoralen Plus Ultraviolet A in Patients with Severe Alopecia Areata: A Retrospective Study with a Self-Controlled Design

In a retrospective study from 2013, 41 patients with severe alopecia areata (AA) were treated with a combination of oral cyclosporine and topical psoralen plus ultraviolet A (PUVA) to evaluate the effectiveness of this treatment regimen. Cyclosporine was administered at a daily dose of 200 mg for adults and 100 mg for children for up to 16 weeks, while eight-methoxypsoralen was applied topically before UVA exposure, with patients receiving UVA irradiation twice a week for 16 weeks. Out of the 41 patients, 2 (4.9%) were lost to follow-up, and 1 (2.4%) discontinued treatment due to side effects. Of the 32 patients who completed the treatment, 3 (9.4%) showed excellent response, 3 (9.4%) showed good response, 12 (37.5%) showed fair response, and 14 (43.7%) showed poor response. The study concluded that while the results are limited by the lack of a control group, the combination therapy with cyclosporine and PUVA may be a viable option for severe and treatment-resistant AA.