Tacrolimus

Is it effective against hair loss?

As of today, we have a substantial number of studies on tacrolimus and its effects on hair, as well as on the conditions that can lead to hair loss.

These studies demonstrate that it has moderate efficacy against alopecia areata but is particularly effective against eczema and seborrheic dermatitis, both of which can contribute to hair loss if they appear on the scalp.

Tacrolimus is also a treatment used in certain cases of scarring alopecia, especially the subtypes characterized by severe and chronic inflammation.

Tacrolimus may treat alopecia areata

Alopecia areata is a form of hair loss characterized by chronic inflammation caused by an autoimmune problem. It has many subtypes which can range from a simple circular patch to complete loss of hair over the whole body.

On the left: patchy alopecia areata; On the right: ophiasis pattern alopecia areata

Tacrolimus is an immunosuppressant that has been tested in several studies for its potential in treating alopecia areata.

Here are a few of these studies:

2022 study : Clobetasol propionate 0.05% vs tacrolimus 0.1% in treatment of alopecia areata

In this 2022 study, researchers compared the effects of a topical preparation of Tacrolimus 0.1% to those of clobetasol propionate 0.05% (a very potent corticosteroid).

The findings revealed that clobetasol propionate was more successful in promoting hair regrowth, with 79.31% of patients in that group experiencing better results, in contrast to only 44.82% in the tacrolimus group.

Consequently, they concluded that clobetasol propionate is the superior option for treating alopecia areata.

2013 study : Tacrolimus 0.1% and minoxidil 2% in alopecia areata

In this 2013 study, tacrolimus 0.1% and minoxidil 2% were tested on 75 patients suffering from alopecia areata.

The study lasted for 12 weeks, and interestingly, minoxidil 2% proved to be more effective than tacrolimus 0.1%. That being said, some patients achieved excellent results with tacrolimus.

For instance, here are the before and after photos of a patient suffering from alopecia areata barbae:

Tacrolimus in the treatment of Cicatricial alopecia

Cicatricial alopecia is a type of hair loss that encompasses various subtypes. Some of them are triggered by bacterial or fungal infections, while others have genetic or environmental causes, and some result from chronic inflammations.

Tacrolimus, functioning as an immunosuppressant, has been extensively studied in the context of various cicatricial alopecia subtypes and has demonstrated its effectiveness in certain instances :

• Frontal Fibrosing Alopecia
• Lichen Planopilaris
• Central centrifugal cicatricial alopecia
• Folliculis decalvans
• Discoid lupus

2023 study : Tacrolimus 0.1% on different subtypes of cicatricial alopecia

For instance, in a 2023 study, topical tacrolimus was applied to multiple subtypes of cicatricial alopecia, such as lichen planopilaris, discoid lupus, frontal fibrosing alopecia, erosive pustulosis of the scalp, and folliculitis decalvans.

This solution was administered to 22 patients over several months, and its efficacy was assessed. The findings revealed that after one month, 63.6% of patients exhibited a favorable response, while 31.8% displayed an excellent response. After two months, 72.7% showed excellent improvement, and this progress continued after six months of treatment.

Here are some before and after photos of the study:

On the left: dyscoid lupus, before and after one month of using tacrolimus 0.1%. On the right: folliculitis decalvans before and after one month of using tacrolimus 0.1%.

As you can see, tacrolimus effectively reduces the inflammation that characterizes these conditions.

2012 and 2018 studies : Tacrolimus in the treatment of frontal fibrosing alopecia and folliculitis decalvans

As mentioned in the study above, tacrolimus is effective in the treatment of several subtypes of scarring alopecia. Here are two studies that also confirm this:

• In a 2012 study, topical tacrolimus was found to be effective in treating folliculitis decalvans, a form of cicatricial alopecia. This treatment helped manage the disease, curbing inflammation, and preventing its progression.
• In a 2018 study involving 92 patients suffering from frontal fibrosing alopecia, researchers observed that tacrolimus was the treatment leading to the quickest stabilization of hair loss.

Nevertheless, it is crucial to note that Tacrolimus is not typically the initial treatment choice for cicatricial alopecia. Physicians resort to it in some cases when first-line treatments have proven ineffective.

Tacrolimus may reduce seborrheic dermatisis and seborrheic alopecia

Seborrheic dermatitis is a common skin condition that causes flaky, dry, white to yellowish scales on oily areas of the skin. It commonly affects the scalp, causing red, itchy, and greasy flaking that can lead to seborrheic alopecia – a form of hair loss due to inflammation from seborrheic dermatitis.

Several studies demonstrate that tacrolimus is effective in the treatment of seborrheic dermatitis. For instance, in a study conducted in 2003, 16 individuals suffering from seborrheic dermatitis used a topical solution of tacrolimus 0.1% for 6 weeks.

They discovered that it effectively alleviated skin redness and scaling. Most participants experienced significant improvements without any serious side effects, although some reported temporary itching or burning at the application site.

In another study carried out in the same year, 18 patients with seborrheic dermatitis were almost completely treated with just 28 days of application of tacrolimus 0.1%.

Tacrolimus may treat Psoriasis

According to a study conducted in 2016, oral tacrolimus also proved to be effective for psoriasis in patients who had not responded well to other treatments.

Around 73% of patients experienced a 75% decrease in their symptoms, while 42% saw an impressive 90% reduction. Significantly, no severe side effects were reported.

To explain it in simple terms, psoriasis causes skin cells to grow too quickly, resulting in red, thick, scaly patches on the skin. It is an immune disorder where the immune system attacks healthy skin cells by mistake. Psoriasis can be itchy and uncomfortable.

Here is an example of psoriasis :

However, it is important to note that tacrolimus is an immunosuppressant, and its oral use carries more risks than its topical version. Therefore, it should be used cautiously and under medical supervision.

Tacrolimus may treat Eczema

Eczema is a skin condition that causes itchy, red, dry patches on the skin. It happens when the skin barrier that keeps moisture in and irritants out does not work properly. This allows moisture to escape and irritants to enter, which leads to itchiness and inflammation.

The skin of people with eczema is very sensitive and easily irritated. Eczema often runs in families and can flare up due to environmental triggers like stress, weather changes, or certain fabrics touching the skin. With eczema, the immune system overreacts to these irritants, causing more inflammation. Applying moisturizers and avoiding flare triggers are important ways to manage eczema symptoms and prevent the very itchy, painful rashes from occurring.

There are several studies that demonstrates the effectiveness of topical 0.1% Tacrolimus in relieving atopic dermatitis, which is commonly known as eczema.

In a 2022 study, tacrolimus at concentrations of 0.1% and 0.3%, along with moderate-potency corticosteroids, were tested on 152 children suffering from moderate to severe eczema.

All treatments proved to be effective, whether it was the two different concentrations of tacrolimus or the corticosteroids. However, the children who used tacrolimus had low traces of the medication in their blood, which did not lead to any side effects.

As I mentioned earlier, tacrolimus, being an immunosuppressant, can potentially pave the way for infections if it is used incorrectly and is not under the control of a physician.

Closing thoughts and verdict

I believe that Tacrolimus could be an effective treatment for different subtypes of cicatricial alopecias, eczema and seborrheic alopecia.

As for alopecia areata, it might work for some individuals, but I think it would be better to consider more effective treatments.

As with all medications, it may not be effective for everyone. Since it is generally not considered a first-line treatment, I would recommend exploring other more effective treatments before considering Tacrolimus for any of the conditions I mentioned earlier.

For instance, there may be cases of alopecia areata where Tacrolimus proves to be effective when other treatments that are supposed to be more efficient have not yielded results.

Precautions & side effects

The key point to understand is that Tacrolimus is an immunosuppressant medication that should be administered with careful medical oversight.

Side Effects

• Headache
• Tremors
• High blood pressure
• Nausea or vomiting
• Diarrhea or constipation
• Swelling of hands/feet
• Abnormal liver function
• Increased risk of infection
• Increased blood sugar or diabetes
• Kidney problems
• Nerve damage (tingling or numbness)
• Insomnia and nightmares
• Hair loss

Precautions

• Tell your doctor about any other medications you are taking, including over-the-counter medicines, vitamins and herbal supplements. Tacrolimus interacts with many other drugs.
• Do not eat grapefruit or drink grapefruit juice, as this can increase tacrolimus levels in your blood.
• Tacrolimus can increase your risk of infection, including activation of latent viral infections. Avoid contact with people who have active infections.
• Tacrolimus suppresses your immune system, decreasing your ability to fight infections. Wash your hands often and report any signs of infection to your doctor promptly.
• Tacrolimus may increase your risk for skin cancer and other cancers. Wear protective clothing and sunscreen when outdoors.
• Tacrolimus can cause high blood pressure. Have your blood pressure monitored regularly.
• Kidney function and blood glucose should be periodically checked while on this medication.
• Do not receive any vaccines without your doctor’s approval while taking tacrolimus. Some immunizations may be unsafe.