Hair Growth in Patients With Alopecia Areata Totalis After TreatmentWith Simvatatin and Ezetimibe

Alopecia areata is an autoimmune disorder characterized by the sudden development of a circumscribed patch of nonscarring hair loss on the scalp or any hair-bearing surface. The presentation of this disorder can be hair loss in a single circumscribed patch, complete loss of hair on the scalp (alopecia totalis) or complete loss of hair on the entire body (alopecia universalis). The following cases involve two patients with treatment-refractory alopecias that benefited significantly after treatment with a combination of ezetimibe and simvastatin, in addition to the continuation of intra-lesional corticosteroid injections. In this report, the known immunomodulatory effects of statins in combination with ezetimibe are discussed along with the known histopathologic findings of autoimmune alopecia. Major histocompatibility complex class II (MHC-II) and intracellular adhesion molecule-1(ICAM-1) appear to be involved in both the immunomodulatory effects of statins and the pathophysiology of autoimmune alopecia.