Synergistic therapeutic effect of systemic steroids and dithranol in a patient of alopecia totalis—A case report

Alopecia areata (AA) is an autoimmune disorder characterized by patchy, non-scarring hair loss. Anthralin (dithranol) is a topical irritant that has shown efficacy in treating AA. Despite its therapeutic potential, there is a common belief that combining steroids with dithranol may reduce its effectiveness. This report presents a case of alopecia totalis in which a combination of systemic steroids and dithranol was used with a synergistic therapeutic effect. A 12-year-old boy with a six-month history of complete scalp hair loss was diagnosed with alopecia totalis. He was treated with betamethasone pulse therapy and Derobin TM ointment (a combination of coal tar, salicylic acid, and dithranol) and applied to both halves of the scalp on a rotational basis. The patient misunderstood the instructions, applying the ointment only to one side while taking systemic steroids. After 2 months, hair regrowth was observed exclusively on the treated side, demonstrating the potential synergistic effect of the combined treatment. Anthralin promotes hair regrowth by inhibiting pro-inflammatory cytokines, while steroids also reduce these cytokines, suggesting a possible synergistic effect. Our case highlights that combining systemic steroids with dithranol can reduce irritation, improve compliance, and enhance hair regrowth. The findings suggest that this combination could be effective for managing severe AA with minimal side effects. The combination of dithranol and systemic steroids may offer a promising approach to treating alopecia areata, enhancing regrowth while minimizing irritation.