Treatment of Pediatric Alopecia Areata With Anthralin Immunotherapy

Anthralin has been used as a form of immunotherapy for alopecia areata (AA) since 1979.¹⁻² Its minimal systemic toxicity makes it an ideal candidate for pediatric AA.³

Thirty-seven AA patients < 18 years from a retrospective review were treated with anthralin at Cleveland Clinic from 2004 to 2015. Topical therapies included application of anthralin 0.5%–1.2% cream or 1% shampoo.

Response was measured by changes in the severity of alopecia tool (SALT) from start of anthralin therapy, either by photography if available, or as documented in the medical records if photography was not available. Mean duration of follow-up on anthralin was 29.7 months.

Maximal Response to Anthralin Therapy in Pediatric Alopecia Areata Patients (N = 37)

2004 – 2015

Sixteen (64%) of the responders experienced at least one relapse after maximal regrowth. Response to anthralin and relapse rates did not significantly differ with different AA subtypes or age groups.

Treatment Outcome by Subgroups (N = 37)

2004 – 2015

Scalp irritation is expected and therapeutic with anthralin use. Efficacy may be limited by a lengthy, gradual response, occasional severe cases of local skin irritation, and a relatively high rate of recurrence. Four patients (11%) discontinued anthralin due to severe irritation.

  1. Schmoeckel C, Weissmann I, Plewig G, Braun-Falco O. Treatment of alopecia areata by anthralin-induced dermatitis. Arch Dermatol.1979;115(10):1254-1255.
  2. Sasmaz S, Arican O. Comparison of azelaic acid and anthralin for the therapy of patchy alopecia areata: a pilot study. Am J Clin Dermatol. 2005;6(6):403-406.
  3. Fiedler-Weiss VC, Buys CM. Evaluation of anthralin in the treatment of alopecia areata. Arch Dermatol.1987;123(11):1491-1493.