Alopecia areata is a common type of non-scarring alo¬pecia. Although the exact pathogenesis remains elusive, alopecia areata is thought to have a multifactorial etiology described as an interplay of genetic predisposition and environmental exposures. In patients with genetic susceptibility, stress, infection, and microtrauma have been documented to decrease immunosuppressive cytokines that generally maintain the hair follicle's immune privilege. There is currently no curative therapy for alopecia areata, although some treatments can induce hair growth in a percentage of patients. It has been postulated that simvastatin reestablishes the immune privilege, and ezetimibe would provide an immunomodulatory and anti-inflammatory effect. We report a case of a 23 years-old woman with alopecia areata successfully treated with simvastatin/ezetimibe.

Authors: Javier Arellano[1,2], Carolina Carrasco[2], Carolina García[2]

Affiliation:
[1] Servicio de Dermatología Hospital Clínico San Borja Arriarán. Santiago, Chile
[2] Departamento de Dermatología, Facultad de Medicina, Universidad de Chile, Santiago, Chile

E-mail: carolinac86@gmail.com

Author address:
[1] Santos Dumont 999,
Independencia, Santiago,
Chile

Citation: Arellano J, Carrasco C, García C. A report of successful management with simvastatin plus ezetimibe in alopecia areata. Medwave 2020;20(10):e8053 doi: 10.5867/medwave.2020.10.8053

Submission date: 19/4/2020

Acceptance date: 13/10/2020

Publication date: 2/11/2020

Origin: Not commissioned.

Type of review: Externally peer-reviewed by three reviewers, double-blind.

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1. Pratt CH, King LE Jr, Messenger AG, Christiano AM, Sundberg JP. Alopecia areata. Nat Rev Dis Primers. 2017 Mar 16;3:17011. | CrossRef | PubMed |
2. Simakou T, Butcher JP, Reid S, Henriquez FL. Alopecia areata: A multifactorial autoimmune condition. J Autoimmun. 2019 Mar;98:74-85. | CrossRef | PubMed |
3. Robins DN. Case reports: alopecia universalis: hair growth following initiation of simvastatin and ezetimibe therapy. J Drugs Dermatol. 2007 Sep;6(9):946-7. | PubMed |
4. Megiorni F, Pizzuti A, Mora B, Rizzuti A, Garelli V, Maxia C, et al. Genetic association of HLA- DQB1 and HLA-DRB1 polymorphisms with alopecia areata in the Italian population. Br J Dermatol. 2011 Oct;165(4):823-7. | CrossRef | PubMed |
5. Cervantes J, Jimenez JJ, DelCanto GM, Tosti A. Treatment of Alopecia Areata with Simvastatin/Ezetimibe. J Investig Dermatol Symp Proc. 2018 Jan;19(1):S25-S31. | CrossRef | PubMed |
6. Lattouf C, Jimenez JJ, Tosti A, Miteva M, Wikramanayake TC, Kittles C, et al. Treatment of alopecia areata with simvastatin/ezetimibe. J Am Acad Dermatol. 2015 Feb;72(2):359-61. | CrossRef | PubMed |
7. Morillo-Hernandez C, Lee JJ, English JC 3rd. Retrospective outcome analysis of 25 alopecia areata patients treated with simvastatin/ezetimibe. J Am Acad Dermatol. 2019 Sep;81(3):854-857. | CrossRef | PubMed |
8. 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. | CrossRef | PubMed |
9. Freitas Gouveia M, Trüeb RM. Unsuccessful Treatment of Alopecia Areata with Simvastatin/Ezetimibe: Experience in 12 Patients. Skin Appendage Disord. 2017 Aug;3(3):156-160. | CrossRef | PubMed |
10. Krysiak R, Zmuda W, Okopien B. The effect of ezetimibe, administered alone or in combination with simvastatin, on lymphocyte cytokine release in patients with elevated cholesterol levels. J Intern Med. 2012 Jan;271(1):32-42. | CrossRef | PubMed |
11. Namazi MR. Statins: novel additions to the dermatologic arsenal? Exp Dermatol. 2004 Jun;13(6):337-9. | CrossRef | PubMed |
12. Gomez-Zubiaur A, Saceda-Corralo D, Velez-Velazquez MD, Vano-Galvan S. Tratamiento de la alopecia areata, un recorrido desde las opciones terapéuticas clásicas hasta los nuevos fármacos aparecidos en los últimos años. Dermatol Online J. 2018 Jul 15;24(7):13030/qt4ft667kk. | PubMed |

Pratt CH, King LE Jr, Messenger AG, Christiano AM, Sundberg JP. Alopecia areata. Nat Rev Dis Primers. 2017 Mar 16;3:17011. | CrossRef | PubMed |

Simakou T, Butcher JP, Reid S, Henriquez FL. Alopecia areata: A multifactorial autoimmune condition. J Autoimmun. 2019 Mar;98:74-85. | CrossRef | PubMed |

Robins DN. Case reports: alopecia universalis: hair growth following initiation of simvastatin and ezetimibe therapy. J Drugs Dermatol. 2007 Sep;6(9):946-7. | PubMed |

Megiorni F, Pizzuti A, Mora B, Rizzuti A, Garelli V, Maxia C, et al. Genetic association of HLA- DQB1 and HLA-DRB1 polymorphisms with alopecia areata in the Italian population. Br J Dermatol. 2011 Oct;165(4):823-7. | CrossRef | PubMed |

Cervantes J, Jimenez JJ, DelCanto GM, Tosti A. Treatment of Alopecia Areata with Simvastatin/Ezetimibe. J Investig Dermatol Symp Proc. 2018 Jan;19(1):S25-S31. | CrossRef | PubMed |

Lattouf C, Jimenez JJ, Tosti A, Miteva M, Wikramanayake TC, Kittles C, et al. Treatment of alopecia areata with simvastatin/ezetimibe. J Am Acad Dermatol. 2015 Feb;72(2):359-61. | CrossRef | PubMed |

Morillo-Hernandez C, Lee JJ, English JC 3rd. Retrospective outcome analysis of 25 alopecia areata patients treated with simvastatin/ezetimibe. J Am Acad Dermatol. 2019 Sep;81(3):854-857. | CrossRef | PubMed |

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. | CrossRef | PubMed |

Freitas Gouveia M, Trüeb RM. Unsuccessful Treatment of Alopecia Areata with Simvastatin/Ezetimibe: Experience in 12 Patients. Skin Appendage Disord. 2017 Aug;3(3):156-160. | CrossRef | PubMed |

Krysiak R, Zmuda W, Okopien B. The effect of ezetimibe, administered alone or in combination with simvastatin, on lymphocyte cytokine release in patients with elevated cholesterol levels. J Intern Med. 2012 Jan;271(1):32-42. | CrossRef | PubMed |

Namazi MR. Statins: novel additions to the dermatologic arsenal? Exp Dermatol. 2004 Jun;13(6):337-9. | CrossRef | PubMed |

Gomez-Zubiaur A, Saceda-Corralo D, Velez-Velazquez MD, Vano-Galvan S. Tratamiento de la alopecia areata, un recorrido desde las opciones terapéuticas clásicas hasta los nuevos fármacos aparecidos en los últimos años. Dermatol Online J. 2018 Jul 15;24(7):13030/qt4ft667kk. | PubMed |