Authors: Val Constantine S. Cua, Juan Paolo David S. Villena, Felix Paolo J. Lizarondo, Claudine Y. Silva


Background: Alopecia areata is postulated to be an autoimmune hair disorder characterized by patches of hair loss. Corticosteroids have been utilized to treat the said disorder, but efficacy has proven to be subpar when applied to severe and extensive variants such as alopecia areata totalis, alopecia areata universalis, and ophiasis. Prolonged steroid therapy leads to side effects such as skin atrophy, weight gain, Cushing syndrome, immunosuppression, and hypothalamic-pituitary-adrenal axis suppression, while discontinuation of the treatment leads to high relapse rate. There is a need for alternative treatment modalities with better safety profile and sustained treatment response to address this dilemma.

Objectives: To determine the efficacy and adverse effects of azathioprine as a treatment for severe forms of alopecia areata.

Methods: Observational and interventional studies that utilized azathioprine as a treatment for alopecia areata were obtained from all published articles until July 2018 on MEDLINE, Cochrane Library, TRIP and Herdin, Google Scholar electronic databases.

Results: The search strategy yielded 8 articles of which 7 qualified for the full-length review. The observational studies and the pre-post studies showed that with azathioprine, the amount of time to hair regrowth is decreased. The non-randomized clinical trial revealed that azathioprine is as effective as oral corticosteroids in treating alopecia areata, with lesser side effects and no relapse rate for the duration of the study.

Conclusion: This review demonstrates emerging evidence on the efficacy of azathioprine for the treatment of extensive forms of alopecia areata. Randomized-controlled trials are needed to evaluate its efficacy.





alopecia areata, alopecia totalis, alopecia universalis, azathioprine, systematic review

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