Systemic Therapies for Scarring and Non-Scarring Alopecia

October 2017

Carolyn Goh

scarring alopecia non-scarring alopecia sulfasalazine hydroxychloroquine simvastatin ezetimibe JAK inhibitors tofacitinib ruxolitinib abatacept IL-12/IL-23p40 cytokine antagonism alopecia areata alopecia totalis Jakafi Xeljanz

From the encyclopedia

Tofacitinib →

a JAK inhibitor for alopecia areata and other autoimmune conditions

Alopecia Areata →

autoimmune disorder causing patchy hair loss

Studysummary JAK inhibitors are effective for hair regrowth in severe alopecia areata.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

The document reviewed systemic therapies for scarring and non-scarring alopecia, highlighting treatments such as sulfasalazine, hydroxychloroquine, simvastatin/ezetimibe, and JAK inhibitors. Sulfasalazine showed promise for alopecia areata, while hydroxychloroquine was ineffective for alopecia totalis. Simvastatin/ezetimibe had potential for hair growth in alopecia areata patients. JAK inhibitors, including tofacitinib and ruxolitinib, were effective in inducing hair regrowth in moderate-to-severe alopecia areata, with studies involving up to 90 patients. Other treatments like abatacept and IL-12/IL-23p40 cytokine antagonism also showed potential in reversing extensive alopecia areata.

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Research cited in this study

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355 citations , January 2017 in “Journal of the American Academy of Dermatology”

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139 citations , November 2016 in “Journal of the American Academy of Dermatology”

In this retrospective review, tofacitinib treatment was associated with clinically significant hair regrowth in most adolescent patients with alopecia areata, though limitations suggest further studies are needed to confirm these findings.

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238 citations , November 2016 in “Journal of The American Academy of Dermatology”

In this study, tofacitinib was reported to improve scalp hair regrowth in patients with severe alopecia areata, alopecia totalis, and alopecia universalis, showing a higher response in alopecia areata.

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222 citations , September 2016 in “JCI insight”

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196 citations , September 2016 in “JCI insight”

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176 citations , August 2015 in “The journal of allergy and clinical immunology/Journal of allergy and clinical immunology/The journal of allergy and clinical immunology”

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58 citations , January 2015 in “Journal of the American Academy of Dermatology”

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This study found that most patients with folliculitis decalvans showed improvement and remission with oral antibiotics, although some experienced relapses and required prolonged treatment.

research Comparison of High-Dose Corticosteroid Pulse Therapy and Combination Therapy Using Oral Cyclosporine with Low-Dose Corticosteroid in Severe Alopecia Areata

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This study found that corticosteroid pulse therapy may be more effective than oral cyclosporine with corticosteroid for patients with severe alopecia areata, especially for those with the plurifocal type or a short disease duration.

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research Alopecia Areata Is Driven by Cytotoxic T Lymphocytes and Is Reversed by JAK Inhibition

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This study found that JAK inhibitors promote hair regrowth in both mice and human alopecia areata cases by blocking key immune pathways involved in disease development.

research Alopecia Areata: An Evidence-Based Treatment Update

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This review analyzed randomized controlled trials on alopecia areata treatment and found that while several treatments showed effectiveness, most studies had limitations affecting their interpretability.

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102 citations , April 2014 in “International Journal of Dermatology”

This study found that early intervention and treatment with intralesional triamcinolone acetonide may stabilize hairline recession in patients with frontal fibrosing alopecia, although further research is needed for definitive treatment guidelines.

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339 citations , February 2014 in “Journal of The American Academy of Dermatology”

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research A Randomized, Active- and Placebo-Controlled Study of the Efficacy and Safety of Different Doses of Dutasteride Versus Placebo and Finasteride in the Treatment of Male Subjects with Androgenetic Alopecia

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research The Effectiveness of Finasteride and Dutasteride Used for 3 Years in Women with Androgenetic Alopecia

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This study found that both finasteride and dutasteride effectively increased hair thickness in women with androgenetic alopecia over three years, with dutasteride performing better in women under 50 at specific scalp sites.

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research Tinea Capitis Mimicking Dissecting Cellulitis of the Scalp: A Histopathologic Pitfall When Evaluating Alopecia in the Post-Pubertal Patient

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71 citations , December 2013 in “The journal of investigative dermatology. Symposium proceedings/The Journal of investigative dermatology symposium proceedings”

This review discusses various treatments for alopecia areata, highlighting their limitations and individualized approach, and reports no new clinical results.

research The Effect of Oral Cyclosporine in the Treatment of Severe Alopecia Areata

33 citations , October 2013 in “Cutaneous and ocular toxicology”

This article discusses the autoimmune pathogenesis of alopecia areata and reviews the use of immunosuppressive therapies in its treatment, but it does not provide new clinical results.

Lichen Planopilaris Treated by the Peroxisome Proliferator-Activated Receptor-γ Agonist Pioglitazone: Lack of Lasting Improvement or Cure in the Majority of Patients

research Lichen Planopilaris Treated by the Peroxisome Proliferator-Activated Receptor-γ Agonist Pioglitazone: Lack of Lasting Improvement or Cure in the Majority of Patients

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research Finasteride Use in the Male Infertility Population: Effects on Semen and Hormone Parameters

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research Successful Treatment of Alopecia Totalis with Hydroxychloroquine: Report of 2 Cases

11 citations , May 2013 in “Journal of the American Academy of Dermatology”

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research Male Breast Cancer and 5α-Reductase Inhibitors Finasteride and Dutasteride

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research Treatment of Frontal Fibrosing Alopecia and Lichen Planopilaris: A Systematic Review

117 citations , March 2013 in “Journal of the European Academy of Dermatology and Venereology”

This study reported that while no effective treatment exists for frontal fibrosing alopecia, oral 5-alpha-reductase inhibitors showed the most promise, inducing a good clinical response in 45% of patients.

research Frontal Fibrosing Alopecia: A Retrospective Review of 19 Patients Seen at Duke University

98 citations , January 2013 in “Journal of The American Academy of Dermatology”

This study reported that while various treatments for frontal fibrosing alopecia showed limited effectiveness, dutasteride most effectively stabilized the condition among patients at Duke University.

research Finasteride 5 mg/Day Treatment of Patterned Hair Loss in Normo-Androgenetic Postmenopausal Women

44 citations , January 2013 in “International Journal of Trichology”

This study found that 5 mg/day oral finasteride was effective and safe for improving hair outcomes in normoandrogenic postmenopausal women with androgenetic alopecia over 18 months.

research Combination Therapy With Finasteride and Low-Dose Dutasteride in the Treatment of Androgenetic Alopecia

17 citations , June 2012 in “Australasian Journal of Dermatology”

This study found that adding low-dose dutasteride to ongoing finasteride treatment significantly improved hair density in a patient with androgenetic alopecia.

research Winding the Clock Back on Female Androgenetic Alopecia

9 citations , May 2012 in “British Journal of Dermatology”

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research Global Photographic Assessment of Men Aged 18 to 60 Years with Male Pattern Hair Loss Receiving Finasteride 1 mg or Placebo

35 citations , February 2012 in “Journal of The American Academy of Dermatology”

This study found that finasteride (1 mg) significantly increased hair growth in all scalp regions affected by male pattern hair loss over 24 months in men aged 18 to 60, with more pronounced effects in younger men.

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75 citations , December 2011 in “British Journal of Dermatology”

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22 citations , August 2011 in “Journal of the American Academy of Dermatology”

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research Prevalence and Etiology of Central Centrifugal Cicatricial Alopecia

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research Medical and Environmental Risk Factors for the Development of Central Centrifugal Cicatricial Alopecia

88 citations , April 2011 in “Archives of Dermatology”

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research Prospective Cohort Study on the Effects and Tolerability of Flutamide in Patients with Female Pattern Hair Loss

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87 citations , March 2011 in “Australasian Journal of Dermatology”

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185 citations , March 2011 in “The Journal of Sexual Medicine”

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research Treatment of Female Pattern Hair Loss with the Androgen Receptor Antagonist Flutamide

30 citations , March 2011 in “Australasian Journal of Dermatology”

This case report found that a woman's hair loss, which progressed while using spironolactone and topical minoxidil, reversed after switching to flutamide therapy.

research Atrichia With Papular Lesions

8 citations , January 2011 in “International journal of trichology”

This report discusses the accurate diagnosis of atrichia with papular lesions, emphasizing its distinction from alopecia universalis to prevent unnecessary steroid treatment, and presents a case matching APL diagnostic criteria.

research Alopecia in Vitamin D-Dependent Rickets Type II Responding to 1α-Hydroxycholecalciferol

3 citations , December 2010 in “Annals of tropical paediatrics”

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research Central Hair Loss in African American Women: Incidence and Potential Risk Factors

76 citations , November 2010 in “Journal of The American Academy of Dermatology”

In this study, a photographic scale and questionnaire revealed that extensive central scalp hair loss was observed in 5.6% of African American women, with an association to a history of tinea capitis.

research Efficacy and Safety of Finasteride Therapy for Androgenetic Alopecia

152 citations , October 2010 in “Archives of Dermatology”

This study found that daily oral finasteride may increase hair count and improve hair appearance assessments in men with androgenetic alopecia, but it also appears to raise the risk of sexual dysfunction.

research Frontal Fibrosing Alopecia: A Clinical Review of 36 Patients

159 citations , August 2010 in “British journal of dermatology/British journal of dermatology, Supplement”

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research 5 mg/Day Finasteride Treatment for Normoandrogenic Asian Women with Female Pattern Hair Loss

64 citations , June 2010 in “Journal of The European Academy of Dermatology and Venereology”

This study suggests that 5 mg/day oral finasteride may increase hair density and thickness in normoandrogenic Asian women with female pattern hair loss over 12 months.

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92 citations , June 2010 in “Journal of The American Academy of Dermatology”

This study found that 0.5 mg of dutasteride significantly improved hair growth compared to placebo and was well tolerated over six months in men with male pattern hair loss.

research Androgenetic Alopecia in the Pediatric Population: A Retrospective Review of 57 Patients

53 citations , March 2010 in “British Journal of Dermatology”

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research Possible Protective Effect of Hydroxychloroquine on Delaying the Occurrence of Integument Damage in Lupus: Data from a Multiethnic Cohort

58 citations , January 2010 in “Arthritis Care & Research”

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research Lichen Planopilaris Treated With a Peroxisome Proliferator-Activated Receptor Gamma Agonist

105 citations , December 2009 in “Archives of dermatology”

This overview discusses primary cicatricial alopecias, focusing on lichen planopilaris, and highlights the challenges in treatment and the progressive nature of hair loss despite symptom management, without providing new clinical results.

research Alefacept for Severe Alopecia Areata: A Multicenter, Double-Blind, Randomized, Placebo-Controlled Clinical Trial

43 citations , November 2009 in “Archives of dermatology”

This study found that alefacept showed no significant improvement in treating severe alopecia areata compared to placebo over a 24-week period.

research Lichen Planopilaris: Retrospective Study and Stepwise Therapeutic Approach

43 citations , March 2009 in “Archives of dermatology”

No treatment showed clear superiority for lichen planopilaris.

research Lichen Planopilaris: Update on Diagnosis and Treatment

160 citations , March 2009 in “Seminars in Cutaneous Medicine and Surgery”

This article reviews lichen planopilaris, its presentation, and treatment challenges, and emphasizes the need for more research into its pathogenesis and therapy efficacy; it reports no new findings.

research Finasteride Induced Gynecomastia: Case Report and Review of the Literature

29 citations , January 2009 in “International Journal of Trichology”

This report describes two cases of gynecomastia linked to the use of Finasteride (Propecia®) for treating androgenetic alopecia, highlighting a rare but important side effect.

research Frontal Fibrosing Alopecia: Clinical Presentations and Prognosis

155 citations , September 2008 in “British journal of dermatology/British journal of dermatology, Supplement”

This study observed that frontal fibrosing alopecia predominantly affects postmenopausal women, can be associated with lichen planus, and may lead to progressive hairline recession, though this progression is not consistent in all cases.

research Treatment of Persistent Alopecia Areata with Sulfasalazine

45 citations , July 2008 in “International Journal of Dermatology”

This study found that oral sulfasalazine led to varying hair regrowth outcomes in patients with persistent alopecia areata, with 56.3% showing moderate to good responses.

research Folliculitis Decalvans: A Rare Inflammatory Scalp Disorder

112 citations , July 2008 in “Dermatologic Therapy”

This review outlines the diagnosis and management of folliculitis decalvans, an inflammatory scalp disorder, and highlights Staphylococcus aureus and immune response deficiencies as key factors in its development.

research Pseudopelade of Brocq: A Review of a Rare Hair Disorder Leading to Cicatricial Alopecia

39 citations , July 2008 in “Dermatologic Therapy”

This review provides a practical approach to diagnosing pseudopelade of Brocq and updates on treatment options but reports no new clinical results.

research Successful Treatment of Perifolliculitis Capitis Abscedens et Suffodiens With Combined Isotretinoin and Dapsone

22 citations , October 2007 in “JDDG Journal der Deutschen Dermatologischen Gesellschaft”

In this case study, combination therapy with dapsone and isotretinoin significantly improved perifolliculitis capitis abscedens et suffodiens, with the patient remaining symptom-free for six months on reduced medication.

research A Case-Series of 29 Patients with Lichen Planopilaris: The Cleveland Clinic Foundation Experience on Evaluation, Diagnosis, and Treatment

113 citations , May 2007 in “Journal of the American Academy of Dermatology”

This study suggests that tetracycline may be more effective for treating lichen planopilaris than previously thought, alongside topical high-potency and intralesional corticosteroids.

research The Effect of 5α-Reductase Inhibition with Dutasteride and Finasteride on Semen Parameters and Serum Hormones in Healthy Men

195 citations , February 2007 in “The Journal of Clinical Endocrinology and Metabolism”

In this study, administering 5alpha-reductase inhibitors reduced dihydrotestosterone levels and was associated with mild, reversible decreases in semen parameters in healthy men.

The Importance of Dual 5α-Reductase Inhibition in the Treatment of Male Pattern Hair Loss: Results of a Randomized Placebo-Controlled Study of Dutasteride Versus Finasteride

research The Importance of Dual 5α-Reductase Inhibition in the Treatment of Male Pattern Hair Loss: Results of a Randomized Placebo-Controlled Study of Dutasteride Versus Finasteride

215 citations , November 2006 in “Journal of The American Academy of Dermatology”

This study found that dutasteride increased scalp hair growth in men with male pattern hair loss, particularly at a 2.5 mg dose, and was more effective than finasteride over 24 weeks.

research Finasteride Treatment of Female Pattern Hair Loss

108 citations , March 2006 in “Archives of Dermatology”

This study observed that 62% of premenopausal women with female pattern hair loss reported improvement when treated with oral finasteride and an oral contraceptive containing drospirenone and ethinyl estradiol.

research A Comparison of the Efficacy, Relapse Rate, and Side Effects Among Three Modalities of Systemic Corticosteroid Therapy for Alopecia Areata

97 citations , January 2006 in “Dermatology”

This study found that intramuscular triamcinolone acetonide or pulse therapy effectively treats alopecia areata with manageable side effects, but further strategies are needed to reduce relapse rates.

research Effective Treatment of Female Androgenic Alopecia with Dutasteride

33 citations , October 2005 in “PubMed”

In this case study, significant improvement in androgenic alopecia was observed in a 46-year-old woman after 9 months of treatment with dutasteride following limited success with finasteride.

research Prevalence of Male and Female Pattern Hair Loss in Maryborough

193 citations , August 2005 in “Journal of Investigative Dermatology Symposium Proceedings”

This study found that the prevalence of androgenetic alopecia increases with age among both men and women in Maryborough, Australia, with 57% of women and 73.5% of men aged 80 and over affected.

research Treatment of Female Pattern Hair Loss With Oral Antiandrogens

179 citations , March 2005 in “British Journal of Dermatology”

This study found that 88% of women with female pattern hair loss who received oral antiandrogens saw no progression or improvement in their condition.

research Placebo-Controlled Oral Pulse Prednisolone Therapy in Alopecia Areata

141 citations , February 2005 in “Journal of the American Academy of Dermatology”

In this study, oral prednisolone pulse therapy led to significant hair regrowth in some patients with extensive alopecia areata, whereas no improvement was seen in the placebo group.

research Erosive Pustular Dermatosis of the Scalp: A Case Report and Review of the Literature

49 citations , January 2005 in “Dermatology”

This case study found that isotretinoin treatment achieved complete resolution of erosive pustular dermatosis of the scalp in a patient, suggesting systemic retinoids as a potential treatment option.

research Frontal Fibrosing Alopecia in Postmenopausal Women

179 citations , December 2004 in “Journal of The American Academy of Dermatology”

This study observed that frontal fibrosing alopecia in postmenopausal women involves selective follicular inflammation, and finasteride treatment may slow disease progression, suggesting a potential androgen-related component.

research Marked Suppression of Dihydrotestosterone in Men with Benign Prostatic Hyperplasia by Dutasteride, a Dual 5α-Reductase Inhibitor

408 citations , May 2004 in “The Journal of clinical endocrinology and metabolism/Journal of clinical endocrinology & metabolism”

This study found that dutasteride more effectively reduced serum dihydrotestosterone levels than finasteride in patients with benign prostatic hyperplasia.

research Vitamin D-Dependent Rickets Type II with Alopecia: Two Case Reports and Review of the Literature

31 citations , September 2003 in “International Journal of Dermatology”

This report describes two Saudi brothers with Vitamin D-dependent rickets Type II and emphasizes the association of this disorder with alopecia.

research Efficacy and Tolerability of Finasteride 1 mg in Men Aged 41 to 60 Years with Male Pattern Hair Loss

22 citations , July 2003 in “PubMed”

This study reported that finasteride 1 mg significantly improved hair growth in men aged 41 to 60 with predominantly vertex male pattern hair loss over 24 months compared to placebo.

research Effects of In Utero Exposure to Finasteride on Androgen-Dependent Reproductive Development in Male Rats

118 citations , May 2003 in “Toxicological Sciences”

This study found that prenatal exposure to finasteride in rats led to permanent changes in developmental endpoints like anogenital distance and nipple retention, which were predictive of further reproductive tract malformations.

research Postmenopausal Frontal Fibrosing Alopecia

57 citations , January 2003 in “Clinical and experimental dermatology”

This study identified postmenopausal frontal fibrosing alopecia as a distinct form of scarring alopecia in postmenopausal women, noting a potential link with a history of bilateral oophorectomy.

research Treatment of Hyperandrogenic Alopecia in Women

108 citations , January 2003 in “Fertility and Sterility”

This study found that flutamide at 250 mg daily modestly improved hair thinning in premenopausal women with hyperandrogenic alopecia over one year, while cyproterone acetate and finasteride were not effective.

research Cutaneous Lupus Erythematosus: A Review

149 citations , July 2002 in “Dermatologic clinics”

This review discusses the pathogenesis, clinical presentation, diagnosis, and treatment of cutaneous lupus erythematosus, reporting no new clinical findings.

research Sulfasalazine for Alopecia Areata

62 citations , April 2002 in “Journal of the American Academy of Dermatology”

In this study, sulfasalazine treatment resulted in cosmetically acceptable hair regrowth in 23% of patients with severe alopecia areata in whom a response could be determined.

research Lichen Planopilaris Treated With Thalidomide

37 citations , December 2001 in “Journal of the American Academy of Dermatology”

This case report details significant hair regrowth in a patient with lichen planopilaris after treatment with thalidomide, suggesting its potential as a treatment option for this condition.

research Finasteride: Does It Affect Spermatogenesis and Pregnancy?

2 citations , December 2001 in “PubMed”

In this review, the authors found no evidence of harmful pregnancy outcomes from exposure to finasteride, and report that handling the medication poses negligible risk to a fetus.

research Lack of Efficacy of Finasteride in Postmenopausal Women with Androgenetic Alopecia

239 citations , November 2000 in “Journal of The American Academy of Dermatology”

In this study, finasteride 1 mg/day for 12 months did not improve hair growth or slow hair thinning in postmenopausal women with androgenetic alopecia compared to placebo.

Measuring Reversal of Hair Miniaturization in Androgenetic Alopecia by Follicular Counts in Horizontal Sections of Serial Scalp Biopsies: Results of Finasteride 1mg Treatment of Men and Postmenopausal Women

research Measuring Reversal of Hair Miniaturization in Androgenetic Alopecia by Follicular Counts in Horizontal Sections of Serial Scalp Biopsies: Results of Finasteride 1mg Treatment of Men and Postmenopausal Women

145 citations , December 1999 in “Journal of Investigative Dermatology Symposium Proceedings”

Finasteride 1mg helps reverse hair miniaturization in men and postmenopausal women.

Chronic Treatment with Finasteride Daily Does Not Affect Spermatogenesis or Semen Production in Young Men