Coacillium, an herbal medicine consisting of four extracts, has shown efficacy as a topical treatment in a phase II/III study in children and adolescents with moderate to severe alopecia areata. What is striking about the results of the study is that the effect of treatment in the nodal group continued to increase after the end of the active treatment phase.
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The pathogenesis of alopecia areata (AA) depends on the migration of cytotoxic T lymphocytes from the circulation into peri- and intrafollicular areas. This process is primarily mediated by adhesion molecules expressed by activated endothelial cells. AA manifests itself in rapid hair loss, which can affect small, limited areas of the scalp, but also the entire body including eyebrows and eyelashes. Hair follicles do not die, which is why hair can grow back in AA. However, frequent and recurrent courses are common.
A critical advance in the treatment of AA has been achieved with the approval of two Janus kinase (JAK) inhibitors. However, these substances are prescribed for adults and adolescents with severe alopecia areata. People with moderate AA, that is, the largest group of patients, as well as children benefit only to a very limited extent from this development due to lack of consent, according to Prof. Dr. Ulrike Blom-Pitafi of the Charité Medical University in Berlin, who also points out that effective intervention after the first appearance of AA, perhaps already in childhood, can have a disease-modifying effect and prevent progression or chronology. Bloom-Pitafi also notes that relapses often occur after discontinuing a JAK inhibitor. As part of the EADV 2023 conference, results of a phase II/III study in the indication for alopecia areata using a phytoremedial agent were presented.