Clobetasol propionate 0.05% under occlusion in the treatment of alopecia totalis/universalis

doi:10.1067/mjd.2003.423

Journal of the American Academy of Dermatology

Volume 49, Issue 1, July 2003, Pages 96-98

https://doi.org/10.1067/mjd.2003.423 Get rights and content

Abstract

Background: Efficacy of topical steroids in alopecia areata is still discussed. Objective: The purpose of this study was to evaluate the efficacy of clobetasol propionate 0.05% ointment under occlusion in 28 patients with alopecia areata totalis (AT) or AT/alopecia universalis. Methods: A total of 28 patients were instructed to apply 2.5 g of clobetasol propionate to the right side of the scalp every night under occlusion with a plastic film. Treatment was performed 6 days a week for 6 months. When regrowth of terminal hair occurred, treatment was extended over the entire scalp. All patients were followed up for another 6 months. Results: Of the 28 patients included in the study, 8 were treated successfully (28.5%). Regrowth of terminal hair began on the treated side 6 to 14 weeks after the start of treatment. Of these 8 patients, 3 had a relapse and were not able to maintain hair regrowth. Conclusion: Our study shows that clobetasol propionate 0.05% under occlusion is effective in inducing hair regrowth in patients with AT or AT/alopecia universalis. Occurrence of hair regrowth only on the treated half of the scalp clearly shows that efficacy of treatment is a result of a local and not systemic effect of the drug. Although only 17.8% of patients had long-term benefit by treatment, our results were obtained in a population of patients with severe and refractory forms of the disease. (J Am Acad Dermatol 2003;49:96-8.)

Section snippets

Material and methods

A total of 28 patients, 16 male and 12 female, aged from 17 to 42 years (mean: 22 years), agreed to be included in the study. Among them, 19 had AT and 9 had AT/AU. Duration of the disease ranged from 3 to 12 years (mean: 7 years). In 7 patients the first episode of alopecia areata had occurred before the age of 10 years. Associated diseases included autoimmune thyroiditis (3 patients), nail abnormalities (8 patients) including 2 patients with twenty-nail distrophy, and atopy (5 patients).

Results

The results of our study are reported in Table I.

. Results of the study

Characteristics	Responders	Poor/Nonresponders
No. of patients	8 (28.5%)	20(71.4%)
Mean age (y)	20.5	23.5
Duration (y)	6.2	7.2
Male/female	2/6	14/6
Nail abnormalities	5 (17.8%)	3(10.7%)
AT/AT and AU	6/2	13/7
Family history of AA	4 (14.2%)	12(42.8%)
Atopy	1 (3.5%)	4(14.2%)
Autoimmune thyroid disease	1 (3.5%)	2(7.1%)
First onset of AA before the age of 10 y	1 (3.5%)	6(21.4%)
Development of folliculitis during treatment	2 (7.1%)	9(32.1%)

AA, Alopecia areata; AT,

Discussion

The efficacy of topical steroids in alopecia areata is controversial and most authors consider topical steroids to be a placebo treatment.5, 6, 7, 8 The efficacy of topical steroids is undoubtedly influenced by the potency and penetration of the drug.

One study incontestably showed the efficacy of occlusive treatment with topical fluocinolone acetonide in AT/AU using the half-side technique.⁹ These authors reported hair regrowth in 6 of 9 patients with AT. Their results were surprisingly better

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^☆: Funding sources: None.

^☆☆: Conflict of interest: None identified.

^★: Reprint requests: Antonella Tosti, MD, Department of Dermatology, University of Bologna, Via Massarenti 1-40138 Bologna, Italy. E-mail: [email protected].

^★★: 0190-9622/2003/$30.00 + 0

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TherapyClobetasol propionate 0.05% under occlusion in the treatment of alopecia totalis/universalis☆,☆☆,★,★★

Abstract

Section snippets

Material and methods

Results

Discussion

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

Systemic steroids with or without 2% topical minoxidil in the treatment of alopecia areata

Arch Dermatol

The fingertip unit-a new practical measure

Clin Exp Dermatol

Current and potential agents for the treatment of alopecia areata

Curr Pharm Des

Therapy
Clobetasol propionate 0.05% under occlusion in the treatment of alopecia totalis/universalis☆,☆☆,★,★★