Review of the literature and report of personal experience on treatment with statins in alopecia areata.

1. Repurposing Drugs for Alopecia Areata:
The Vytorin Experience
Antonella Tosti

2. Simvastatin/ezetimibe in alopecia areata
Statins have an anti
inflammatory and
immunomodulatory
effects that can be of
potential benefit in
autoimmune disorders

3. Simvastatin/ezetimibe in alopecia areata
Block IFN-γ-induced
MHC II expression
Suppress T cell
activation/ proliferation
Modulate Jak/Stat
pathway

4. Simvastatin/ezetimibe in alopecia areata
First report of described in 2007.
Patient with AU had complete
hair regrowth 1 months after
starting the combination
simvastatin/ezetimibe.
The same patient did not have
regrowth when previously
treated with simvastatin alone
Robins DN. Case reports: alopecia universalis: hair growth following initiation of
simvastatin and ezetimibe therapy. J Drugs Dermatol. 2007 Sep;6(9):946-7.

5. Simvastatin/ezetimibe in alopecia areata
Two patients
Also treated with intralesional
steroids
Initial regrowth 3 weeks-6
months
Ali A, Martin JM 4th. Hair growth in patients alopecia areata totalis after
treatment with simvastatin and ezetimibe. J Drugs Dermatol. 2010 Jan;9(1):62-4.

6. Simvastatin/ezetimibe in alopecia areata
Small open study
29 enrolled patients, 40% to 70% of scalp involvement
using the North American Hair Research Society (NAHRS)
scale
Simvastatin/ezetimibe 40 mg/10 mg daily for 24 weeks
At baseline and every 8 weeks, global photography and
standard laboratory tests were performed.
Subjects who showed more than 20% hair regrowth on
week 24 using the NAHRS scale were considered positive
responders

7. Simvastatin/ezetimibe in alopecia areata
19 patients completed 24 weeks of treatment, and 14 / 19
were responders.
At 24 weeks the 14 responders randomized into 2 groups:
A, 7 of 14 patients continued treatment for 24 weeks
5/7 mantained the regrowth
B, 7 of 14 patients stopped medication
5/7 had a relapse

8. Simvastatin/ezetimibe in alopecia areata
Lattouf C, Jimenez JJ, Tosti A, Miteva M, Wikramanayake TC, Kittles C, Herskovitz I,
Handler MZ, Fabbrocini G, Schachner LA. Treatment of alopecia areata with
simvastatin/ezetimibe. J Am Acad Dermatol. 2015 Feb;72(2):359-61.
Statistical analysis showed
positive association between
being on therapy and stable
remission

9. Simvastatin/ezetimibe in alopecia areata
Small open study in severe alopecia areata
20 patients older than 18 years, with AA totalis/universalis
or involvement of the scalp greater than 70%
Simvastatin/ezetimibe 40 mg/10 mg daily for 24 weeks
17 (85%) patients completed the study .
Loi C, Starace M, Piraccini BM. Alopecia areata (AA) and treatment with
simvastatin/ezetimibe: Experience of 20 patients. J Am Acad Dermatol. 2016
May;74(5):e99-e100

10. Simvastatin/ezetimibe in alopecia areata
Fourteen of 17 (82%) patients had no hair regrowth,
Two (12%) had a transient diffuse hair regrowth followed by
total hair loss in 1 month during the treatment period,
One (6%) patient had a patchy regrowth of pigmented hair
(<20%)
Loi C, Starace M, Piraccini BM. Alopecia areata (AA) and treatment with
simvastatin/ezetimibe: Experience of 20 patients. J Am Acad Dermatol. 2016
May;74(5):e99-e100

11. Can topical statins
be an option?
DelCanto GM,Petit VA, Vila Granda A, Alcazar O, Perez CI, Elgart GW,
Schachner LA, Jimenez JJ. Treatment with Simvastatin Decreases pStat1
Levels and Reverses AA in the C3H/HeH Mouse Model. 9th World Congress for

12. Can statins be utilized to prevent relapse ?
48 Mice
24
Heat Treatment
Simvastatin (40 mg/Kg/IP)
24
Heat Treatment
Only
Jimenez et al in press

13. Can statins be utilized to prevent relapse ?
Heat treatment
induces protein stress
response“HSPs”
resulting in AA in the
mouse model

14. Can statins be utilized to prevent relapse ?
Retrospective study
42 patients with alopecia areata ageing 18 to 72 years
Hair regrowth with other treatments (defined as change in
SALT score > 50%)
Simvastatin/ezetimibe 10/40 added to regimen
Unpublished

15. Can statins be utilized to prevent relapse ?
Retrospective study
30 severe AA including ophiasis (8)
12 AT/AU
Treatments : clobetasone propionate 0.05%under
occlusion+ pulse systemic steroids,topical
immunotherapy,anthralin

16. Can statins be utilized to prevent relapse ?
Retrospective study
At 6 months :
31/ 42 patients had minimal or no relapses and continued
treatment
At 12 months :
11 of the 31 patients had disease relapse ( mild 5 severe
6) when discontinued treatment for personal reasons or
side effects

17. Can statins be utilized to prevent relapse ?
Retrospective study

18. Thank you!
atosti@med.miami.edu