title: Combination therapy with oral PUVA and corticosteroid for recalcitrant alopecia areata.
abstract: Alopecia areata (AA) is regarded as a tissue-specific autoimmune disease for which several therapies have been suggested to modify the immune reaction against HFs, such as contact immunotherapy, psoralen plus ultraviolet A (PUVA), corticosteroids, cyclosporine, minoxidil, and dithranol. However, severe type AA, such as alopecia totalis (AT) and alopecia universalis (AU), often show resistance against these therapies. We applied a combination therapy with oral corticosteroid and oral PUVA for intractable cases of AT and AU. These patients took 20 mg/day corticosteroid and were irradiated with UVA on the whole body 2 h after taking methoxsalen for 1 month. In all patients, the terminal hair on the whole scalp regrew after 2 months. Two patients had a relapse of hair loss 3 months after the termination of the treatment. FACS analysis revealed that the CD4+CD25(high) and CD4+CD25+FOXP3+ Treg population in PBMC was increased after the combination therapy. Furthermore, the number of infiltrating cells decreased and FOXP3+ cells were often found in lesion skin after the combination therapy. Mitogen-induced proliferation tests showed low responses against PHA and Con A after the combination therapy. Taken together, the combination therapy may modify the systemic immune system and increase the number of Treg cells, resulting in improvement of recalcitrant AA.
authors.affiliation: Department of Dermatology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan. itoutai@hama-med.ac.jp
authors.forename: Taisuke
authors.initials: T
authors.lastname: Ito
authors.forename: Masahiro
authors.initials: M
authors.lastname: Aoshima
authors.forename: Natsuho
authors.initials: N
authors.lastname: Ito
authors.forename: Izumi
authors.initials: I
authors.lastname: Uchiyama
authors.forename: Keiko
authors.initials: K
authors.lastname: Sakamoto
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kawamura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yagi
authors.forename: Hideo
authors.initials: H
authors.lastname: Hashizume
authors.forename: Masahiro
authors.initials: M
authors.lastname: Takigawa
mesh_terms: D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000506:Alopecia Areata / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D015704:CD4 Antigens; D002465:Cell Movement / Q000187:drug effects / Q000276:immunology; D002469:Cell Separation; D004351:Drug Resistance; D005260:Female; D005434:Flow Cytometry; D051858:Forkhead Transcription Factors; D006197:Hair / Q000187:drug effects* / Q000254:growth & development / Q000473:pathology; D006801:Humans; D007165:Immunosuppression Therapy; D053645:Interleukin-2 Receptor alpha Subunit; D008213:Lymphocyte Activation / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D011701:PUVA Therapy; D012867:Skin / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D050378:T-Lymphocytes, Regulatory / Q000187:drug effects / Q000276:immunology / Q000378:metabolism* / Q000473:pathology
chemical_list: D000305:Adrenal Cortex Hormones; D015704:CD4 Antigens; C418974:FOXP3 protein, human; D051858:Forkhead Transcription Factors; D053645:Interleukin-2 Receptor alpha Subunit