Antihistamines, Dupilumab May Improve Hair Growth in Alopecia Areata

A man with alopecia
A man with alopecia
Some antihistamines may serve as potential monotherapy or adjunct therapy for alopecia areata.

The following article is part of coverage from the American Academy of Dermatology’s Annual Meeting (AAD 2020). Because of concerns regarding the coronavirus disease 2019 (COVID-19) pandemic, all AAD 2020 sessions and presentations were transitioned to a virtual format. While live events will not proceed as planned, readers can click here to view more news related to research presented during the AAD VMX 2020 virtual experience.

Treatment with antihistamines oxatamide, fexofenadine, and ebastine were associated with significant hair regrowth in patients with alopecia areata (AA), whereas treatment with dupilumab produced inconsistent results, according to study results presented at the American Academy of Dermatology’s Virtual Meeting Experience (AAD VMX) 2020, held online from June 12 to 14, 2020.

The study was a primary literature review according to PRISMA guidelines of articles that reported AA treatment with antihistamines or dupilumab. Articles were also included if they reported development of AA because of these treatments. A total of 24 articles comprising 326 patients with AA were included in the review.

There were 11 studies that reported treatment with antihistamines, including oxatamide (n=152), fexofenadine (n=133), ebastine (n=26), cimetidine (n=1), hydroxyzine hydrochloride (n=1), and unspecified medication (n=1). Aside from cimetidine, all antihistamines were histamine 1-receptor blockers. The most common antihistamines were twice-daily 30 mg oxatamide, 60 or 120 mg/day fexofenadine, and 10 mg/day ebastine. The other 13 articles discussed treatment with dupilumab.

Antihistamines were associated with positive hair growth in all studies except for 1 case study that used ebastine. Most patients treated with antihistamines across studies experienced reductions in pruritus and erythema. In 7 case reports, all 7 patients who received dupilumab experienced significant improvements in hair growth. Dupilumab may have caused AA (n=6) and drug-induced alopecia (n=1). Case reports also reported patchy hair loss on the scalp (n=7) and beard (n=1) within an 18-week period of starting dupilumab.

The number of AA cases included in the study and the inherent difficulty of conducting AA studies were cited by the researchers as study limitations.

The researchers noted that the association “between AA and AD warrants further exploration regarding the efficacy of dupilumab in the treatment of patients AA-related concomitant diseases.”

Visit our conference section for more coverage from AAD VMX 2020.


Pham C, Sung C, Juhasz M, Yuan J, Mesinkovska N. The role of antihistamines and dupilumab in the management of alopecia areata: a systematic review. Presented at: AAD VMX 2020; June 12-14, 2020. Abstract/Poster 18783.