Background: Alopecia areata (AA) is a common autoimmune disease mediated by T lymphocytes. AA is characterized by the rapid onset of non-scarring hair loss causing a burden for many patients. Spontaneous remission occurs frequently. Treatment is difficult in refractory cases. Because of disappointing results of other treatment options we treated 5 patients with refractory alopecia areata totalis and universalis using Sulfasalazine for 6 months.

Objective: Sulfasalazine has been safely used in the long-term treatment of various inflammatory and autoimmune disorders. Based on various articles in the literature we applied sulfasalazine for six months in order to induce remission of refractory AA.

Material and Methods: Five patients received sulfasalazine at an increasing dosage starting with 500mg per day for a period of six months. All patients showed long-time AA totalis and have been treated with a variety of therapies (topical and systemic corticosteroid, minoxidil, Diphenylcyclopropenon, photochemotherapy) and none of them yielded constant improvement..

Results: Three patients with AA totalis and completed the treatment. Two patients dropped out because of side effects. During treatment and after a follow up period of four months no patient showed signs of hair regrowth.
Conclusion: In our small study Sulfasalazine did not demonstrate any clinical improvement of AA, questioning its role as therapeutic alternative in the treatment of AA. Totalis or universalis