An uncontrolled, open label study of sulfasalazine in severe alopecia areata

Background: Alopecia areata (AA) is an autoimmune disease mediated by T lymphocytes. Many treatments have been used but their results remain disappointing. There is a need to propose new therapeutic alternatives. Methods: During a period of 3 years, 26 patients with recalcitrant or severe AA (>40 hair loss) were enrolled in an open-label uncontrolled clinical trial. According to the response to sulfasalazine, patients were grouped into 3 categories: no hair regrowth ( 10 terminal hair), partial hair regrowth (10-90 terminal hair), and complete hair regrowth (90-100 terminal hair). Efficacy evaluation was performed with clinical examination. Results: Twenty-two patients completed the treatment. Overall, 68.2 (15 of 22 patients) responded to therapy: 27.3 (6 of 22 patients) achieved complete hair regrowth, and 40.9 had partial hair regrowth. Seven (31.8) patients had no hair regrowth. Of the 22 patients with complete and partial remission, 10 (45.5) suffered a partial or complete relapse. Side effects following treatment were seen in 7 (31.8) patients. Conclusion: Sulfasalazine could be considered as a therapeutic alternative in the treatment of AA, because of its safety profile, cosmetically acceptable efficacy, and good tolerability.