Anthralin Irritation Treatment for Alopecia Areata
Alopecia areata is a condition that is chronic and leads to hair loss of different scales. It can be limited to small areas on the scalp but can also affect areas such as eyebrows, eyelashes, beards, body hair or any combination of these, with the worst form involving total loss of all hair from the head and body. It can be a long lasting condition and may well last all of the patient’s life.
One of the treatments used to combat the disease is Anthralin irritation treatment. Anthralin, also known as Zithranol-RR is the synthetic substitute for chrysarobin a substance extracted from the South American araroba tree. It is used in plaque psoriasis to reduce the growth of affected skin cells.
Effect of treatment
Anthralin is a comparatively effective irritant and was used when applications of other non-irritants had failed to create hair growth. It is not really understood why anthralin works but it is felt that it prevents normal cell growth and differentiation in the skin. It has been shown in laboratory tests that it generates both oxygen radicals and free radicals and inhibits epidermal growth factor signalling. As it is only successful in a limited number of cases anthralin is generally used as a second line of treatment.
Application of treatment
Normally a 0.5% anthralin is applied to the skin in cream or liquid form. This is then left for a controlled period before it is washed away. The exact time and concentration of the anthralin is dependent on the patient’s response to the treatment and the severity of the disease. Originally in patients with alopecia areata it was attempted to promote hair growth by inducing a non-allergic inflammatory dermatitis. Anthralin was applied as an ointment once a day, in a concentration of 0.2% to 0.8%, to the affected areas but where the condition was extensive it was applied to a small area to try to prevent spontaneous growth. If the application induced blistering, itching, or swelling of the lymph nodes then treatment was suspended for a few days.
Result of treatment
When hair growth was observed the treatment continued for several weeks and about 6-8 weeks after that hair re-growth was first observed, the hair can appear to be grey which will take some time to pigment to normal color. In a study of 32 patients with patchy alopecia areata, cosmetically acceptable hair growth was noted. Three had only short term re-growth, and three failed. In a case of 8 alopecia totalis patients two showed fairly good cosmetically acceptable hair growth, one had transient hair growth and three failed to respond. This demonstrates the difficulty facing medical staff in their attempts to find a cure for the condition. It is well known that all people react to different treatments in different ways so it is never easy to find a cure-all treatment.
It has been reported that cosmetically acceptable hair re-growth after an unspecified time had been successful in 75% of those patients with patchy alopecia areata and in 25% of those with alopecia totalis. They had been treated once a day and new hair growth was apparent after about 8 weeks, but those who showed no progress after 3 months were taken out of the treatment program. Those who did respond were treated for a further 6 months until cosmetically acceptable hair re-growth was seen.
Side effects
As anthralin is well known for its use in treating psoriasis the side effects could be reasonably expected. Skin staining and irritation were the biggest problems, and the whitening of the hair caused distress to some patients. The more serious side effects that may be induced by the use of anthralin were severe itching, blisters, folliculitis which is the inflammation of one or more follicles, and lymphadenopathy, which is disease or swelling of the lymph nodes.
There are no long term effects reported in the use of anthralin and compared to other methods of treatment the side effects are relatively mild and do not occur to a serious level in the majority of patients. There is no mention in any scientific reports of the psychological side effects that occur with the treatment and it is almost certain that these are a bigger cause for concern than the physical effects.
Conclusion
Anthralin irritation treatment may not work for everyone and the results vary from patient to patient. But in general this form of treatment should be considered when all other major forms of treatment have been explored by the patient.