Journal of Cutaneous Pathotogy 1977: 4: 47-50

Topical Halcinonide in Alopecia Areata and in Alopecia Totalis LEOPOLDO V. MONTLS Department of Dermatology. LIniver.sity of Alabama at Birmingham, Ihe Medical Center, Birmingham, Alabama, U.S.A. When halcinonide cream was used for prolonged periods in patients affeeted by alopecia areata or alopecia totalis, marked and steady regrowth of hair was ob.served. Received for pubtication February 15, 1977

As recently sumtnarized, the treatment of alopecia ateata is disappointing (Rook et al. 1972). Although systemic steroids will induce hair regrowth, this effect is seldom pertnanent and not free of side effects, particularly in younger patients. Intralesional or topical steroids can be useful in localized areas but are of limited value when generalized involvement occurs. Our experience with many patients over a period of more than 20 years is in full agreement with the above. Whenever a new topical steroid has becotne available the results of proper trials in our patients have always supported this view. In 1974 halcinonide 0.1% cream was approved in the United States because of its anti-inflammatory, anti-pruritic and va.soconstrictive actions for adjunctive therapy and symptomatic relief of inflammatory manifestations of acute and chronic corticosteroid responsive dermatoses. The list included psoriasis, atopic dermatitis, eczematous dermatitis, seborrheic dermatitis and neurodermatitis. Alopeeia areata and alopecia totalis are not approved indications and no data was presented by the manufacturer (Squihb 1974, Physicians Desk Reference 1 977) to suggest that a significant beneficial effect could be expected in patients affected by these types of hair loss.

Nevertheless, as we had done with earlier steroids and in the ab.sence of any better available treatment, we decided to try this preparation in our patients who were anxiously waiting for something new. Skeptical as before, we started them on a regimen of halcinonide cream B.I.D. with or without occlusion, according to the individual case. The results, as sumtnarized in Table 1 and shown in one patient in Figs, were dramatic. The patients with alopecia totalis required larger amounts of cream than the ones with localized patches. They were instructed not to use more than 60 g of cream (60 mg of halcinonide) over a period of 1 month. Occlusion was facilitated in those patients with extensive scalp involvement because they were wearing a wig which allowed the use of polyethylene film underneath on an almost continuous basis. In none of these patients were there signs of systemic effect from the use of the steroid. Atrophic striae were not observed either. Among the possible local adverse reactions associated with topical steroids, only one instance of mild folliculitis was observed but it was rapidly controlled by topical benzoyl peroxide. Upon normalization of hair growth the patients were advised to gradually reduce the

Fig. 1. Patient 3 before treatment. Fig. 2. Same patient after treatment over a period of 3 months. Fig. 3. Same patient as seen following completion of treatment for one lull year.

HALCINONIDE IN ALOPECIA

49

Tabte I

Summary of data on 10 paticnt.s with alopecia areata and alopecia totalis treated with halcinonide cream Patient No.

Age

Sex

Duration of alopecia

1

42

F

20 months

2

38

3 4 5

53 14 30

F D M

6

62

I-

16 months

7 8

44 16

M !•

1 8 months 1 year

9

42

V

7 yeans

10

40

M

2 months

2 months 1 year 2 years 5 months

Loeation 1 our different plaques involving about 20% of the scalp Round area 6 t'ni in diameter on the occipital region Entire scalp I'ntire .scalp Round plaque 3 cm in diameter on the chin Approximately 90% of the sealp 1 ntire scalp Roimd area 10 em in diameter on the occipital region Throe dilterent plaques involving at:iout 30 % of the sealp Oval plaque 10 X 6 em on the occipital area Roimd plaque 2 em in diameter on the chin

amount of cream being applied. A remarkable result of this treattnent has been the lack of any significant hair loss following discontinuation of the use of the steroid. Because the vehicle of halcinonide cream was not available it was not possible to test its effect, if atiy, in alopecia areata and in alopecia totalis nor to perform double-blind studies. These are needed. Histopathologically, pretreatment biopsies revealed the picture of alopecia areata or alopecia totalis and permitted to exclude alopecia tnucinosa, tinea capitis and other forms of alopecia. We were impressed in four patients hy tJie fact that in follow-up biopsy specimens ob-

Length of treatment needed to aceompli.sh full regrowth of hair 10 months

Oeclusion

6 months

No

1 2 months 1 8 months 1 3 months

Yes Yes No

11 months

Yes

15 months 10 months

Yes No

1 2 months

No

14 month.s

No

16 months

No

No

tained after initiation of treatment, when hair growth was already evident, the inflammatory infiltrate seen before treatment was not markedly reduced. This led us to consider the possibility that the mechanism of action of halcinonide in these patients was not only an anti-inflammatory effect. We wonder if halcinonide itself or halcinonide through another in vivo induced derivative tnay not directly stimulate hair growth. We realize that these results must be substantiated by additional studies. Although perhaps premature, they are presented here in an attetnpt to alleviate other patients and to stimulate further research in this important area of cutaneous pathology.

MONTES

50 References

Rook, A., Wilkinson, D. S. & Ebling, I\ J. G.

(1972) Textbook of Dermatotogy, 2nd ed. Oxford, Blackwell Scientific Publications. Squibb and Sons, E.R. (1974) Ilalog Cteam® J 3 349. Princeton, N.I. Physieians'

Desk Reference

(1977) 31st ed.. pp.

1517-1518. Oradell, NJ, Medical Feonomies Co. IIALCINONIDE

HO

Chemical name:

CH,

21-chloro-9-fluoro-l l/3,16a,l 7trihydroxypregn-4-ene-3,20dione, eyclic 16,17-acetal with acetone Generic name: Halcinonide Trademark name: Halog Cream (SQUIUB) Eaeh gram of Halog Cream contains 1 mg haleinonide (0.1%) in a specially formulated cream base consisting of glyceryl monostearare N.F.XII, eetyl alcohol, synthetic spermaceti, i.sopropyl palmitate, polysorbate 60, propylene glycol, and purified water.

Address: Leopotdo F. Montes Department of Dermatotogy 239 Zeigter Bldg. University of Alabama at Birmingttam Medieal Center Birmingham, Atabama 35294 U.S.A.

Topical halcinonide in alopecia areata and in alopecia totalis.

Journal of Cutaneous Pathotogy 1977: 4: 47-50 Topical Halcinonide in Alopecia Areata and in Alopecia Totalis LEOPOLDO V. MONTLS Department of Dermato...
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