Aldara creme stimuleert hergroei bij Areata!

[pindakaas]

New York - Imiquimod 5 percent cream (Aldara) appears to be an effective treatment for alopecia areata, although a local inflammatory response associated with its use may limit tolerability and patient compliance, dermatology researchers from St. Barnabas Hospital, Bronx, N.Y., reported.

They described treatment of a series of nine alopecia areata patients with a self-administered regimen of imiquimod cream applied in a thin layer, twice daily to affected areas for up to 16 weeks. Although three patients were immediately lost to follow-up, all of the remaining six had evidence of hair regrowth by two weeks after treatment initiation.

Local adverse reactions were noted in three patients at a four-week visit, and two of those individuals subsequently discontinued study participation. Despite response, a sixth patient withdrew to seek alternate treatment after the week eight visit. At 16 weeks three patients had complete hair regrowth that was still present at a post-treatment visit conducted four weeks later.

"Alopecia areata can have a devastating impact on patient self-esteem and quality of life. Available treatments are often ineffective and may be invasive, painful, and costly as well," Amy E. Goldstein, D.O., dermatology resident, said.

"Our experience suggests topical application of imiquimod 5 percent cream offers a potentially effective, non-invasive alternative treatment for patients with alopecia areata. We found that the twice daily regimen worked well. Further studies would need to be done to determine the effectiveness of less frequent dosing, such as once daily or even three times a week."

"This self-administered treatment appears to offer several advantages. It is easy for patients to use, nonpainful, minimizes the number of office visits, and may be rapidly effective, as we noted benefits as early as within two weeks," said dermatology resident Nancy A. Spinelli, D.O., who collaborated with Dr. Goldstein.

Five males and four females ranging in age from 19 to 66 years composed the nine-patient series. Each patient had four or fewer lesions located on the face and/or scalp measuring no more than 4-cm in diameter. Imiquimod was started only after a minimum two-week washout from prior treatment for alopecia areata.

The adverse events noted in three patients at the four-week visit consisted of mild-to-moderate erythema, scaling, and crusting and were treated with topical mupirocin ointment. The three other patients who completed the treatment did not complain or show any visible signs of irritation.

Drs. Goldstein and Spinelli became interested in investigating the efficacy of imiquimod for stimulating hair regrowth in patients with alopecia areata recognizing that it may combine the mechanisms of action of current treatment modalities.

"Topical or systemic immunosuppressives and immunogens/irritants are now used to treat this disease. We postulated that imiquimod, which has both immune-modulating properties and produces local irritation, would be superior to modalities with a single mode of action," Dr. Goldstein said.

The investigators believe imiquimod may address the purported autoimmune etiology of alopecia areata by decreasing antigen presenting cells in the skin and/or inducing irritation that recruits T cells that would provide antigenic competition for follicular antigens. The precise mechanism of imiquimod's efficacy, including determination of the contribution of either of these activities, requires further study.

In the small series reported, only one of the three individuals who experienced complete regrowth developed irritation associated with the treatment.

The resident physicians conducted the research under the direction of Cindy Hoffman, D.O., director of the residency program at St. Barnabas Hospital, and Charles Gropper, M.D., head of the department of dermatology at St. Barnabas and assistant professor of dermatology, Mt. Sinai Medical Center, New York.

Aldara is a product of 3M. The investigators have no financial interest in the company.


http://www.dermatologytimes.com/derm...il.jsp?id=3938

[JaRule17]

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