Comparison of azelaic acid and anthralin for the therapy of patchy alopecia areata: a pilot study

Am J Clin Dermatol. 2005;6(6):403-6. doi: 10.2165/00128071-200506060-00007.


Background: Although topical azelaic acid has been previously used for the treatment of alopecia, no controlled trials of azelaic acid for this condition have been conducted to date.

Objective: The goal of this study was to determine the efficacy, tolerability, and safety of azelaic acid treatment in patients with patchy alopecia areata (AA) in comparison with anthralin (dithranol) treatment.

Subjects and methods: This study included 31 subjects with patchy AA who did not receive any treatment for at least 1 month prior to the study. Demographic and clinical characteristics of these subjects were recorded at baseline. Subjects were randomized to apply either 20% azelaic acid (15 subjects) or 0.5% anthralin (16 subjects) for 12 consecutive weeks. In a subsequent 8-week follow-up period no cream was applied. Two independent investigators performed an efficacy evaluation with clinical examination using a terminal hair regrowth score (RGS) with a scale ranging from 0 (inadequate response) to 2 (complete response) at week 20. Partial response was accepted as score 1.

Results: Both groups were well matched for the relevant demographic and clinical indicators affecting treatment response at baseline. All subjects completed the trial. At week 20 the RGS was 1.27 +/- 0.9 in the azelaic acid group versus 1.37 +/- 0.8 in the anthralin group (p > 0.05). A complete response was observed in 53.3% of cases in the azelaic acid group (8 of 15) compared with 56.2% (9 of 16) in the anthralin group (p > 0.05). No serious adverse events were observed in either group during the study.

Conclusion: The present pilot study showed that the use of azelaic acid gave similar results to anthralin with regard to hair regrowth, and that it can be an effective topical therapy for patchy AA. More extensive trials are necessary, however, to reach a definitive conclusion.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Administration, Topical
  • Adult
  • Alopecia Areata / drug therapy*
  • Anthralin / therapeutic use*
  • Anti-Inflammatory Agents / therapeutic use*
  • Dermatologic Agents / therapeutic use*
  • Dicarboxylic Acids / therapeutic use*
  • Female
  • Hair / growth & development
  • Humans
  • Male
  • Pilot Projects


  • Anti-Inflammatory Agents
  • Dermatologic Agents
  • Dicarboxylic Acids
  • azelaic acid
  • Anthralin