The Use of Sulfasalazine in Alopecia Areata

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This article is from the Medscape Website and it’s ‘Ask The Expert’ section in General Dermatology. The question was about the uses of sulfasalazine in treating alopecia areata, and particularly for use in teenagers. What follows is the expert’s response in which she gives the results of a recent study.

Amy J. McMichael, MD
Associate Professor, Director of Hair Disorders Clinic, Department of Dermatology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina

~Sulfasalazine is an anti-inflammatory medication first used to treat rheumatoid arthritis. It also has been used to treat inflammatory bowel disease, seronegative arthropathies, and psoriasis.^[1] Sulfasalazine, a compound of sulfapyridine and 5-aminosalicylic acid, works as both an immunomodulator and an immunosuppressant medication. It inhibits inflammatory cell chemotaxis and cytokine and antibody production.

The most common side effects are nausea, vomiting, anorexia, dyspepsia, malaise, and headaches. These side effects become especially problematic at doses higher than 3 g per day. Taking the medication with food or using enteric-coated tablets can help minimize gastrointestinal side effects. Rare side effects include fever, rash, hepatitis, pancreatitis, pneumonitis, and agranulocytosis. Liver function tests and complete blood counts should be monitored closely for the first 3 months, then every 3-6 months thereafter. Because sulfasalazine inhibits folate absorption, folate supplementation is recommended. Finally, patients with allergies to sulfa should not be started on sulfasalazine.

Sulfasalazine is not a first-line therapy, but it has been used to treat alopecia areata.