COMPARATIVE EFFICACY OF TOPICAL TACROLIMUS 0.1% VS TOPICAL CLOBETASOL 0.05% IN LIMITED ALOPECIA AREATA

Abstract

Alopecia areata (AA) is a form of hair loss disease that results from autoimmune disorders and is known to impact the psychological wellness of patients [1, 2]. First-line treatment for limited patchy AA is clobetasol propionate 0.05% and tacrolimus 0.1% topical solution, which has been described as a steroid-sparing option. There are also some discrepancies in the efficacy of tacrolimus in AA treatment based on the previous works [3, 4].

Methodology: This study was done in the department of dermatology of PNS Shifa Hospital, Karachi, over a period of six months on a voluntary basis with nonrandomized control samplings. In this study, 60 patients with limited scalp AA with scalp involvement less than 25% were enrolled and divided into two equal groups. The twenty- minute series A (n=30) underwent topical tacrolimus 0.1% twice daily for the skin, while the twenty-minute series B (n=30) was topped up with clobetasol propionate 0.05% twice for the same skin. Efficacy was evaluated employing the Severity of Alopecia Tool (SALT) and the customary regrowth was divided into excellent (> 75%, marked: 51- 75%), moderate (26-50%), and poor (≤ 25%).

Outcomes: At the onset, the members of the two groups were comparable. At the end of the 6 months of the study, the mean SALT score significantly reduced from 14.5% to 8.1% in the tacrolimus group, whereas similar mean SALT score reduced from 14.8% to 2.3% in the clobetasol group, P<0.001 [5]. In Group B, new growth of 50% or more was found in 83%, whereas, in Group A, the same was observed only in 33% of the patients (p<0.001). The time for the regrowth of the hair was also shorter in the clobetasol group; it took a median of 6 weeks for the hair to regrow as compared to those in the placebo group that took 10 weeks [7]. Both the treatments were, however, found to be generally safe but clobetasol was found to cause minor side effects on the skin surface in the form of skin atrophy in patients [8].

Conclusion: It has been found that topical clobetasol 0.05% is a better drug as compared to tacrolimus 0.1% to induce hair regrowth in limited AA. However, tacrolimus has side effects, and, therefore, it yields a lower efficacy and should be considered in cases when patients cannot receive steroids.