Alopecia areata (AA) is a chronic relapsing autoimmune disorder characterised by non-scarring hair loss. This occurs in patches on the scalp but can progress to complete loss of scalp hair (alopecia totalis, AT) or scalp and body hair (alopecia universalis, AU)1. Statins, a class of drugs that inhibit cholesterol biosynthesis, also possess anti-inflammatory and immunomodulatory effects. This includes inhibition of the Janus Kinase (JAK) pathway which is involved in the pathogenesis of AA2. Ezetemibe works synergistically by potentiating the effect of statins3. Previous studies have shown conflicting results with the use of simvastatin/ezetimibe to treat AA in adults4,5.
We present a case of a six year old girl with AU. She had experienced patchy hair loss for a few years with some spontaneous regrowth, which progressed to total body hair loss. Previous treatments included prednisolone, topical clobetasol and diphenylcyclopropenone. Simvastatin 20mg daily and minoxidil were commenced. After two months there was no improvement and the regimen was changed to simvastatin/ezetimibe 40/10mg with minoxidil. Three months later she had some regrowth however then relapsed back to AU, at which point weekly prednisolone (25mg) was added. Regrowth started after two months and two years later she had 90% scalp coverage with normal eyebrows and eyelashes. One residual area of alopecia on the occipital scalp was treated with triamcinolone injections.
The only adverse effect was transaminitis, with alanine aminotransferase (ALT) up to 93 (reference range <30) and aspartate aminotransferase (AST) up to 65 (reference range <40). Interestingly, the ALT and AST increased after reduction in the dose of simvastatin to 20mg. The regimen was changed to second daily dosing and the ALT and AST improved and clinical state remained stable. To our knowledge, this is the first report of successful treatment of AU with simvastatin/ezetimibe in a child.