The Clinical Efficacy and Mechanism of Action of Alitretinoin in the Treatment of Alopecia Areata
- Author:
Jung-Min SHIN
1
;
Bogyeong GO
;
Young-Joon SEO
;
Chang Deok KIM
;
Kyung Eun JUNG
;
Young LEE
;
Moon-Bum KIM
Author Information
- Publication Type:Original Article
- From:Annals of Dermatology 2026;38(2):129-135
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:Alitretinoin, a pan-retinoid receptor agonist approved for chronic hand eczema, exhibits immunomodulatory effects that may benefit alopecia areata (AA). However, clinical evidence for its use in AA is limited.
Objective:To evaluate alitretinoin's clinical efficacy and immunological mechanism in patients with AA.
Methods:We reviewed retrospectively twenty-one patients with AA who were treated with alitretinoin, either as monotherapy (n=9) or add-on therapy (n=12). Treatment response was assessed using the Severity of Alopecia Tool (SALT) scores, and in vitro studies used human outer root sheath cells stimulated with interferon-γ and polyinosinic:polycytidylic acid to investigate the drug’s effects on inflammatory pathways.
Results:Both groups showed significant reductions in SALT scores (p=0.04 and p=0.02, respectively). Patients with baseline SALT scores below 50 demonstrated superior improvement.Adverse events were mild, with headache (33.3%) and cheilitis (4.8%) being the most common. In vitro, alitretinoin suppressed interleukin-6 and tumor necrosis factor-α expression, decreased phosphorylation of signal transducer and activator of transcription (STAT) 1/STAT3, and downregulated major histocompatibility complex class I expression, suggesting restoration of hair follicle immune privilege.
Conclusion:Alitretinoin appears to be a safe and potentially effective treatment for patients with mild to moderate AA unresponsive to conventional therapies. Its role as a monotherapy or adjunctive option in selected cases warrants further investigation through larger controlled studies.
