The evolution of treatments for alopecia areata through history

Alopecia Areata (AA), a condition characterized by hair loss, has been a challenge for humans throughout history. This essay presents a brief tour of the evolution of treatments for AA, tracing from ancient times up to the present era of advanced therapies.

The ancient Egyptians, as documented in the Ebers Papyrus, proposed several intriguing remedies. These included a topical mixture of fig, sebesten fruit, yellow ochre, frankincense, goose fat, and sweet beer, to be applied directly to the scalp. Queen Cleopatra herself reportedly suggested two treatments, underscoring the historical prominence of AA.

Similarly, the Greek physicians offered a myriad of remedies involving herbs, chemicals, and physical treatments. Celsus, a prominent Roman medical writer, recommended scarifying (making small cuts on) bald patches, while Pliny the Elder, an esteemed Roman author, suggested an onion-honey or onion-vinegar combination. Persian scholar Rhazes reported that Antyllus, a Greek surgeon, advocated for scarification, cupping, and the use of leeches.

During the Middle Ages, AA was commonly attributed to the corruption of blood by black bile. Consequently, the treatment strategies aimed at purifying the blood. The renowned Persian physician Hali Abbas suggested bloodletting, pills, and purges in his influential work “Liber regalis,” translated into Latin by Stephen of Antioch in 1127. The Renaissance brought a wave of new treatment possibilities, largely centered around herbal remedies. By the early 18th century, approaches became more varied, with Turner recommending a host of treatments from rubbing with coarse linen to the application of bay leaf oil and turpentine.

The 19th century saw further evolution in AA treatments. Bateman’s book “on Skin Diseases” suggested methods such as shaving, friction, and the application of oil of Mace dissolved in alcohol. Fox and Wilson endorsed the use of cantharides and lavender oil, iodine and antimony, and even mercury ointment. However, by the early 20th century, consensus was lacking on the most effective approach. In France, where some believed AA was caused by infectious agents, antiseptic treatments remained popular.

Looking back, a common thread that unites many of these therapies is the intent to provoke skin irritation, either physically or chemically. Interestingly, some of these treatments, like irritant treatments (dinitrochlorobenzene and anthralin) and contact sensitization therapies (squaric acid and diphencyprone), are still used today.

The landscape of AA treatment underwent a dramatic shift in the 1950s with the introduction of immuno-suppressive agents. The groundbreaking use of cortisone acetate by Dillaha and Rothman in 1952 marked a turning point. Initially, the exact action mechanism of corticosteroids was unclear; only later was it understood that they act on inflammatory cells. While there have been attempts to develop other immuno-suppressive agents, corticosteroids remain the first-line treatment in most clinics worldwide.

Today, we stand on the threshold of an exciting era of new immuno-regulatory treatments. One such promising therapy is the use of JAK inhibitors. Only time will tell if these novel approaches will become a mainstream therapeutic strategy, changing the face of AA treatment as we know it.

In conclusion, the journey of AA treatment is an incredible testament to human innovation and resilience. From ancient Egyptian concoctions to modern immunosuppressive agents, we have tirelessly sought ways to overcome this ailment. Each step of this journey, no matter how peculiar some remedies might seem today, has contributed to our current understanding and approaches to treating Alopecia Areata.

Bibliography