Systemic immunosuppression

Systemic immunosuppressant medications can help to suppress the immune system to reduce any inflammation occurring around hair follicles. In the UK, methotrexate, ciclosporin and azathioprine are the most used systemic immunosuppressants for alopecia.

Before starting an immunosuppressive treatment, a number of baseline tests are usually required. These tests may include blood samples to check liver & kidney function, blood count, blood fats, for evidence of serious viral infections (hepatitis & HIV) and tuberculosis (TB). Evidence that you are immune to the chickenpox virus is also checked. A chest x-ray may also be carried out. You are likely to be advised to have a vaccination for pneumococcal infection, annual flu vaccines and covid vaccines.

Women who can become pregnant may require to be on an effective form of contraception if sexually active, as some immunosuppressive treatments (e.g. methotrexate) should not be taken during pregnancy.

Regular blood tests are essential to monitor the effectiveness of the treatment and check for any potential side effects.

Systemic immunosuppression might be prescribed to patients with the following types of alopecia:

alopecia areata (including totalis and universalis), frontal fibrosing alopecia (FFA), lichen planopilaris (LPP).

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