Freitas Gouveia Mabe, Trüeb Ralph M
Department of Dermatology, Núcleo de Ensino Superior, São Paulo, Brazil.
Center for Dermatology and Hair Diseases Professor Trüeb, Wallisellen, Switzerland.
Skin Appendage Disord. 2017 Aug;3(3):156-160. doi: 10.1159/000468991. Epub 2017 Apr 22.
BACKGROUND/AIMS: Alopecia areata is a common immune-mediated hair condition with limited treatment options and success rates. There is evidence that statins, which are used for reducing atherogenesis and cardiovascular disease, have immunomodulatory activities and therefore may also be used for treatment of selected dermatologic conditions, including alopecia areata. Among treatments evaluated for alopecia areata, oral simvastatin/ezetimibe therapy is currently under the scrutiny of expert opinion.
Prospective observational study of the efficacy and tolerability of simvastatin/ezetimibe 40/10 mg (Inegy; MSD Merck Sharp & Dohme AG, Lucerne, Switzerland) over a treatment period of 6 months in alopecia totalis, universalis, multipatch involvement of the scalp >30%, ophiasis, or diffuse alopecia areata.
Of the 12 patients included in the study, 67% had no hair regrowth, 24% transient diffuse or patchy hair regrowth, and 24% patchy regrowth of pigmented hair which was not considered cosmetically satisfactory. Adverse effects were observed in 24% of patients, who reported myalgia. One patient showed elevation of creatine phosphokinase.
Simvastatin/ezetimibe is not effective for treatment of alopecia areata, at least in severe and/or cases refractory to other treatments, either as monotherapy or as adjuvant. Ultimately, in choosing such a treatment with questionable benefit, one must take the risk of serious adverse effects into careful consideration.
背景/目的：斑秃是一种常见的免疫介导性毛发疾病，治疗选择和成功率有限。有证据表明，用于降低动脉粥样硬化和心血管疾病风险的他汀类药物具有免疫调节活性，因此也可用于治疗某些皮肤病，包括斑秃。在针对斑秃评估的治疗方法中，口服辛伐他汀/依折麦布疗法目前正受到专家意见的审视。
对12例全秃、普秃、头皮多发斑片受累面积>30%、匐行性斑秃或弥漫性斑秃患者进行前瞻性观察研究，评估辛伐他汀/依折麦布40/10毫克（Inegy；瑞士卢塞恩MSD默克雪兰诺公司）在6个月治疗期内的疗效和耐受性。
纳入研究的12例患者中，67%没有毛发再生，24%有短暂的弥漫性或斑片状毛发再生，24%有色素性毛发斑片状再生，但美容效果不理想。24%的患者出现不良反应，报告有肌痛。1例患者肌酸磷酸激酶升高。
辛伐他汀/依折麦布对斑秃治疗无效，至少在重度和/或对其他治疗难治的病例中，无论是单药治疗还是辅助治疗均无效。最终，在选择这种益处存疑的治疗方法时，必须仔细考虑严重不良反应的风险。
