Cyclosporine A

Cyclosporine A is an immunosuppressive medication that operates by temporarily dampening the immune system’s activity, by inhibition of Calcineurin allowing medical interventions to occur without the body’s immune response interfering.

Typically, this class of drugs is employed to prevent organ rejection in individuals who have undergone liver, kidney, or heart transplantation. It is frequently administered in conjunction with other medications to facilitate the proper functioning of the newly transplanted organ.

In the context of alopecia, the use of Cyclosporine A is relatively uncommon. It is only applied in specific types of alopecia and is primarily administered topically.

Is it effective for hair loss?

Cyclosporine A has been in common use since the 1980s as a medication to suppress graft rejection and autoimmune diseases. However, it often comes with significant side effects, with the least severe but most intriguing being its excessive stimulation of hair growth.

For instance, hypertrichosis has been reported in 60% of individuals who have undergone kidney transplants and were treated with Cyclosporine A. Hypertrichosis, also known as “werewolf syndrome,” is characterized by excessive hair growth on specific parts of the body or even the entire body.

Here is an example of severe hypertrichosis:

Certainly, Cyclosporine A does not induce such severe hypertrichosis, at least not immediately. The medication is administered only temporarily, and hypertrichosis does not have the opportunity to develop in such an extreme manner.

At this juncture, one might inquire about the mechanism by which Cyclosporine A can stimulate hair growth to such an extent.

Based on my research, Cyclosporine A may impact hair loss in the following manner:

Cyclosporine Reduces SFRP1 Expression

According to research from the University of Manchester (source), it appears that Cyclosporine A has the capacity to lower the expression of SFRP1, a protein known to impede the development and growth of various tissues, including hair follicles.

SFRP1 functions as a kind of regulator. When its activity is suppressed, hair is able to grow in areas where this protein had previously blocked its growth. Importantly, it seems that the immunosuppressive properties of Cyclosporine A are unrelated to its impact on SFRP1. This makes SFRP1 a particularly promising new target in the battle against alopecia.

There is also an alternative to Cyclosporine A, a compound known as WAY-316606. This compound similarly acts on SFRP1 but does not possess immunosuppressive properties.

For those interested in studies that have explored whether inhibiting SFRP1 indeed promotes hair growth, several studies with highly promising results can be found (source) (source) (source) (source).

Cyclosporine reduces inflammation and offers treatment for alopecia areata

Inflammation serves as a defense mechanism triggered by the immune system when the body faces various forms of attacks, such as infections, irritations, muscle strains, or injuries.

Interestingly, almost all types of alopecia are characterized by the presence of chronic scalp inflammation. Mitigating this inflammation has proven to be an effective strategy for reducing hair loss.

In our case, Cyclosporine A is an immunosuppressant, meaning it prevents the immune system from functioning. Therefore, logically, it suppresses inflammation and, as a result, reduces hair loss caused by it.

Several studies have been conducted on Cyclosporine A and its effects on alopecia areata, a form of hair loss caused by an autoimmune problem, often manifesting as localized hair loss in circular patches. Its subtypes can lead to complete hair loss or hair loss across the entire body.

Here is an example of alopecia areata:

According to a study, oral administration of Cyclosporine A has been effective in treating alopecia areata by suppressing immune cells in hair follicles.

Other studies have mentioned similarly positive results in the treatment of alopecia areata and its subtypes, such as totalis alopecia (source) (source) (source).

A Korean study conducted in 2008 also demonstrates the effectiveness of oral Cyclosporine A combined with low-dose corticosteroids.

Here are before-and-after photos:

What about topical Cyclosporine?

So far, all the studies have focused on oral Cyclosporine. However, I do not recommend this approach due to the potential for numerous side effects and other considerations.

Immune system suppression is a perilous path that demands rigorous medical supervision. For context, the HIV virus weakens the immune system, leading to a slow decline in an individual’s health.

Moreover, obtaining a doctor’s approval is absolutely essential, and unless you have a severe case of alopecia areata and all other options have been exhausted, they are unlikely to prescribe it. Consequently, it is not a readily accessible treatment for common androgenetic alopecia.

One might think that if oral administration is fraught with risks, topical application could be an alternative. This was an idea I initially considered promising. However, after conducting research on relevant studies, it appears that topically applied Cyclosporine A is not as effective as its oral counterpart:

• The studies on this subject yield somewhat conflicting results. According to one study, applying Cyclosporine for 4 months yielded positive results in 2 out of 8 individuals.
• In a case report, a 23-year-old man with alopecia areata experienced noticeable effects after approximately 10 months of use.
• However, in a 2009 study involving 85 individuals with alopecia areata, topically applied Cyclosporine showed no efficacy in promoting hair regrowth.

Concluding thoughts and verdict

In summary, Cyclosporine A shows potential as an effective treatment option for severe cases of alopecia areata and its variants and it’s indicated in patients with Psoriasis. However, its use should be approached with the utmost caution and under the close supervision of a medical professional.

For individuals dealing with androgenetic alopecia or hair loss of the telogen effluvium type, Cyclosporine A is not a suitable treatment option.

As for the topical form, while it held promise as a potential treatment for androgenetic alopecia, it appears ineffective due to poor skin absorption. However, the exciting prospect lies in the inhibition of SFRP1, which has garnered considerable attention.

I also recommend staying updated through the articles and news section of this website, as a treatment targeting androgenetic alopecia by inhibiting SFRP1 is currently under development and is expected to become available in 2023-2024.

Precautions & Side Effects

This medication should be administered under the close supervision of a healthcare professional.

• It may lead to side effects in certain individuals.
• Possible side effects encompass tremors, headaches, dizziness, abnormal hair growth, nausea/vomiting, diarrhea, stomach discomfort, or hot flashes.
• Gum swelling may occur; regular teeth brushing is advisable in such instances.
• It has the potential to elevate blood pressure.
• It is not recommended for individuals with pre-existing liver or kidney issues, or those currently battling cancer.
• The chance of skin cancer may be raised. Avoid lots of sun, sunlamps, and tanning beds. Use sunscreen and wear clothing and eyewear that protects you from the sun.
•  Some people treated with this drug have had severe kidney problems caused by a certain viral infection (BK virus). In people who have had a kidney transplant, BK virus infection may cause loss of the kidney. If you have questions, talk with the doctor.
•  A very bad and sometimes deadly brain problem called posterior reversible encephalopathy syndrome (PRES) has happened with this drug. Call your doctor right away if you have signs like feeling confused, lowered alertness, change in eyesight, loss of eyesight, seizures, or very bad headache.