Alopecia areata; combination therapy with isotretinoin (0.05%) gel and minoxidil (2%) solution

Abstract

Background Alopecia areata is a common cause of nonscarring hair loss. The cause isunknown but it is associated with an alteration in the immunological system. Treatment foralopecia areata includes topical corticosteroids, dithranol, tretinoin, minoxidil, systemiccortisone, PUVA therapy, irritants and immunosuppressive drugs.Objective Our objective was to assess the efficacy of combination of topical 2% minoxidillotion and isotretinoin (0.05%) gel in the treatment of alopecia areata.Patients and methods From 1st October 2003 till 30th September 2004, over a period of 1year, clinically diagnosed, fresh cases of alopecia areata, fulfilling the inclusion criteria wereenrolled. All the patients were advised to apply minoxidil (2%) solution in the daytime andisotretinoin (0.05%) gel in the night to avoid photosensitivity. The daily treatment wasadvised for a period of four months and thereafter every alternate day for another two monthsas a maintenance therapy. Clinical assessment was carried out by patient’s self-assessment,investigator assessment and clinical evaluation on follow up visits.Results The total number of patients studied was 54 comprising 31 males (57.4%) and 23females (42.6%), male to female ratio being 1.3. Twenty-nine patients (53.7%) had threelesions, 18 (33.3%) had two lesions and seven (13%) only one lesion. Complete restoration ofhair follicles was noted in 45 (83.3%, p<0.001) by the end of therapy. All the patients withsingle patch responded (100%), while 15 patients (83.3%) with 2 lesions recoveredcompletely. Twenty-three patients (79.3%) with 3 lesions had a complete restoration of hairfollicles.Conclusion The combination therapy of minoxidil (2%) solution and isotretinoin (0.05%) gelfor alopecia areata is cost effective, stimulating hair regrowth within a shorter interval and iswell-tolerated.