Meloxicam alone had no effect on basal output of PGE2. Dexamethasone produced a significant, almost doubling of PGE2 output, but this was not altered further by meloxicam. Sulfasalazine alone doubled the output of PGE2, and this increased further in the presence of dexamethasone. That increase was reduced by addition of meloxicam. Indomethacin significantly reduced stimulation of PGE2 output measured after dexamethasone treatment. In addition, indomethacin significantly attenuated the stimulation of PGE2 output seen with the addition of sulfasalazine or the further increase seen with sulfasalazine plus dexamethasone.
Sulfasalazine may also be an effective treatment for some forms of hair loss because of its immunosuppressive actions. Some hair loss is caused by auto-immune responses in the scalp.
Because of its immunomodulatory and immunosuppressive actions, sulfasalazine has shown good hair regrowth in the treatment of alopecia areata. The drug is administered orally usually as enteric-coated tablets to minimize the gastrointestinal side effects. The treatment is started at a lower dose, usually in the range of 500 mg twice daily and then the dose is gradually increased to 1 g three times a day. Adverse effects include gastrointestinal distress, liver toxicity and haemotological side effects. Sulfasalazine helps in alopecia areata because it causes inhibition of T cell proliferation, and natural killer cell activity and also inhibits antibody production. It also inhibits the secretion of interleukin (IL)-2, IL-1, TNF- and IFN-gamma and even IL-667.
A number of clinical studies have documented a positive effect of sulfasalazine in alopecia areata. In one clinical study, 23% patients showed a really good response with satisfactory hair growth after sulfasalazine therapy. Other studies have also shown a beneficial effect of this treatment option in resistant cases of alopecia areata.
British Journal of Medical Practitioners
More to follow.