Efficacy of topical cyclosporin a in the treatment of alopecia areata

A total of 17 patients with alopecia areata refractory to therapy were randomized to receive either a topical solution of cyclosporin A (100 mg/ml) in liposomal vehicle, or liposomal vehicle alone. The patients were required to apply 500 μl twice daily for 4 months to a previously designated 1 cm2 patch of alopecia areata. Photographs of the treated area were taken at baseline and at weeks 4, 8 and 16. Blood samples were taken at baseline and at weeks 2, 8 and 16, to monitor adverse reactions and cyclosporin A levels. Of the 17 patients, 14 (8 cyclosporin A, 6 vehicle) completed the study. A slight decrease in the total number of vellus hairs and a slight increase in the total number of non-vellus (terminal) hairs was noted in both groups. Global severity of patients' hair loss increased slightly in the cyclosporin A group as compared with a slight decrease in the vehicle group. These changes were not statistically significant. Blood levels of cyclosporin A were not detected during the study. Topical cyclosporin A incorporated into liposomes at a concentration of 100 mg/ml failed to stimulate hair regrowth in patients with alopecia areata. Further studies with different formulation strategies such as a higher local concentration of cyclosporin A or better vehicle penetration enhancers, or both, are needed.