The potential efficacy of thalidomide in the treatment of recalcitrant alopecia areata

Thalidomide has been used in the treatment of many dermatological disorders. This drug is a potent suppressor of IL-12 production which plays a critical role in the development of cellular immune responses mediated by helper T-cells. It induces a drop in helper T-cell counts and a corresponding, though relatively small, rise in suppressor T-cells. It seems that cellular, not humoral, immune mechanisms are involved in the pathogenesis of alopecia areata. Also, decreased suppressor T-cell numbers in the active disease have been reported. Therefore, it could be postulated that thalidomide, especially in combination with other agents, could be of help in the treatment of resistant cases of alopecia areata.