Treatment of Alopecia Areata and Alopecia Totalis With Viviscal® (Special Marine Extract Compound)
A. Lassus*, J. Santalahti*, M. Sellmann**
*Helsinki Research Centre-Stora Roberts-Gatan 8 A 1, SF-00120 Helsinki, Finland
**Dermatological Clinic - Freidrich-Ebert -Platz 17, 51373 Leverkusen, Germany
SUMMARY
Twenty patients with alopecia areata (mean duration 9 years) and 20 patients with alopecia totalis (mean duration of 7 years) were treated with 2 pills of Viviscal® Liniment once daily and Viviscal® shampoo 2-3 times/week for eight months. Viviscal® is a preparation containing mainly compound of marine extract and colloidal silicic acid. Both group included 10 females and 10 males. All patients had earlier received topical steroids and 15 had had been treated with systemical corricosteroids. Most of them had also been treated with topical minoxidil and photochemotherapy. Seventeen of the patients with alopecia areata (85%) were completely cured and two showed significant improvement. One of the patients in this group deteriorated during the treatment period. Five (25%) of the patients with alopecia totalis were completely cured and four (20%) showed significant improvement, while 11 patients developed only minimal vellus hair. This promising study showed that Viviscal® is a further complement to the rather short list of remedies which alter the clinical course of alopecia areata and alopecia totalis.
INTRODUCTION
The treatment of alopecia areata and alopecia totalis is usually disappointing and treatment results are difficult to interpret because of spontaneous remissions and recurrences. Topical, intra-lesional or systemical corticosteroid therapy is usually tried, but the benefit is questionable. Systematical corticosteroid treatment may be effective in some cases, but the maintenance doses needed are often too high. In 1977 promising results with the use of topical dinitrochlorbence were reported(1). Later reports that topically used squaric acid may induce regrowth of hair in even severe cases of alopecia areata have been published(2). These treatments have, however, probed to be too topically irritant for practical use. Ultraviolet light has been recommended, but its benefit has not been confirmed. However, it has been reported to stimulate regrowth in some cases(3). In 1974, Rollier and Warcewski(4) first reported that methoxsalen (8-MOP) in combination with natural sunlight may induce hair growth. In 1978, Weissmann et al. (5) reported that the use of topical 8-MOP and UVA-light induced good regrowth in patients with alopecia areata. Similar results were reported by Lassus et al in 1980 and 1984(6,7).
In 1992 Lassus et al.(8) reported excellent regrowth of hair in young males with hereditary androgenic alopecia by using Viviscal® an oral food supplement of mainly marine origin. The present study which was initiated in October 1992 is a therapeutical evaluation of the effect of oral and topical Viviscal® ; for treatment of alopecia areata and alopecia totalis.
PATIENTS AND METHODS
Twenty patients with alopecia areata and 20 patients with alpecia totalis were treated. All had had alopecia for at least two years. In both groups, 10 males and 10 females were treated (Table 1). The mean age of the patients as well as mean weight, length, mean duration of alopecia, site of baldness, earlier treatments and concomitant diseases are illustrated in Table 1.
Before treatment and at each re-examination the cumulative surface-area of the bald areas was measured and the size was expressed in square centimetres. The scalp area showing regrowth of permanent hair was measured and regrowth was expressed as a percentage of the total bald area. All patients took two pills of Viviscal® daily for an eight-month period and applied every evening topically a 1.0% liniment containing the same active ingredients as that of the pills. All patients except those with no hair at any time used a 1.0% shampoo with the same active ingredients as in the Viviscal® pills, 2-3 times weekly.
Pre-examinations were carried out bi-monthly, which involved measuring the regrowth of permanent hair, the degree of hair loss and a photography of the involved areas. In addition, the thickness of epidermis and dermis was measured by the use of a Dermascan-C(9) equipment, an elasticity index was measured with the use of a Dermaflex-A(10) equipment, Cortex Ltd., Denmark and an erythemal index with an erythemal meter(11), Diastron Ltd., UK. All measurements were carried out from the same bald site of the scalp.
Statistical methods were applied to continuous as well as categorical data collected during the study. Categorical data variables were analysed with a standard X-test for homogenity and Fischer's exact test was also used. Results were generated statistically significant if the corresponding P-value was <0.05, but lower than or equal to 0.10.
TABLE 1:
Clinical data of 40 patients with alopecia arata or alopecia totalis.
PARAMETERS 	
ALOPECIA AREATA 	
ALOPECIA TOTALIS 	

Number treated 	
20 	
20 	

Females 	
10 	
10 	

Males 	
10 	
10 	

Mean age (years) 	
32 (27-48) 	
34 (27-52) 	

Mean weight (kgs) 	
63 (20-90) 	
68 (49-85) 	

Mean length (cms) 	
168 (110-187) 	
172 (160-185) 	

Duration of Alopecia (years) 	
9 (2-30) 	
7 (2-28) 	

SITE OF ALOPECIA: 	

Vertex 	
20 	
20 	

Neck 	
11 	
20 	

Temporal region 	
5 	
20 	

EARLIER TREATMENT: 	

Minoxidil (topical) 	
16 	
14 	

Photochemotherapy 	
14 	
12 	

Topical corticosteroids 	
20 	
20 	

Systemical corticosteroids 	
3 	
12 	

CONCOMITANT DISEASES: 	

Atopy 	
15 	
16 	

Diabetes mellitus 	
0 	
3 	

Thyroiditis 	
0 	
1 	

RESULTS
All patients were treated for eight months and showed excellent compliance. In the alopecia areata group the mean bald areas were 118 cm2 at baseline. At the end of the trial 17 patients showed complete regrowth, two had a regrowth > 50% as compared with baseline and one patient showed deterioration (the bald areas had increased size from 63 cm2 to 113 cm2). That was a 43-year-old female who responded well in the beginning of the study, but started to loose hair again after four months of treatment. In the whole group the mean area of baldness was 9.5 cm2 after treatment. The difference as compared with the area of baldness at baseline reached high statistical significant (P <0.001).
In the alopecia totalis group, five patients showed complete regrowth, one patient a regrowth > 50% and three patients a moderate regrowth of permanent hair (30-50%). The remaining 11 patients only minor increase of vellus hair.
All patients in the alpecia areata group had increased hair loss at baseline which had completely stopped after two months of treatment. Nineteen of the 20 patients showed no abnormal hair loss at the end of the treatment.
As shown in Table 3, epidermis had significantly become thicker in both groups during the treatment while the thickness of dermis had remained approximately unchanged. The elasticity index and the erythemal index had significantly increased in both groups.
The only adverse reaction observed during the treatment period was a mild drying of the skin surface of the scalp with concomitant mild scaling. However, this did not require treatment or cause withdrawal from the study.
DISCUSSION
The idea of carrying out the present study came from earlier observations that Viviscal® stimulates hair growth in males with hereditary androgenic alopecia(8). In order to evaluate the effect of Viviscal® in the treatment of alopecia areata, only severe cases without signs of spontaneous regrowth were included in the study. Considering the severe nature of the treated cases, the results were definitely impressive and support earlier results(8) that Viviscal® seems to be highly effective for inducing hair growth. In particular the results in the alopecia totalis group were promising and a longer period of treatment could have further improved results. In contrast to the effect of corticosteroids, Viviscal® and photochemotherapy, seem to be effective in atopic subjects with alopecia areata or alopecia totalis.
The mechanism by which Viviscal® induces regrowth of permanent hair is still not clear. An immunosuppressive effect in combination with increased nutrition may be of importance. However, the mode of action of photochemotherapy is neither clear.
The present findings definitely suggest that Viviscal® may be a new alternative for treatment of alopecia areata and alopecia totalis.
TABLE 2:
Results of treatment.
PARAMETERS 	
ALOPECIA AREATA 	
ALOPECIA TOTALIS 	

Complete cure 	
17 (85%) 	
5 (25%) 	

Improved 	
2 (10%) 	
4 (20%) 	

Unchanged or worse 	
1 (5%) 	
11 (55%) 	

TABLE 3:
Mean thickness of epidermis and dermis, elasticity and erythermal indexes before and after treatment.
	
ALOPECIA AREATA	
ALOPECIA TOTALIS	

	

	

PARAMETERS 	
BEFORE 	
AFTER 	
BEFORE 	
AFTER 	

Epidermis (mm) 	
0.34 	
0.41 	
0.25 	
0.37 	

Dermis (mm) 	
2.71 	
2.67 	
3.05 	
2.77 	

Elasticity index (%) 	
64 	
74 	
62 	
74 	

Erythemal index 	
0.189 	
0.283 	
0.199 	
0.270 	

REFERENCES
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2) Happle R. Buchner U, Kalveram K-J, Echternacht-Happle K. Contact Allergy As A Therapeutic Tool For Alopecia Areata: Comparison Between Dinitrochlorbenzene And Squarie Acid Dibutylester. Arch Dermatol 1979; 264: 101-102.
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9) Serup J, Holm P, Stender I-M, et al. Skin Atrophy And Teleangiectasia After Topical Corticosteroids As Measured Non-Invasively With High Frequency Ultrasound, Evaporimetry And Laser Flowmetry: Methological Aspects including Evaluations Of Regional Differences. Bioeng Skin 1987; 3: 43-58.
10) Serup J, Northeved A. Skin Elasticity In Psoriasis: In Measurement Of Tensile Distensibility, Hysteresis and Resilient Distension With A New Method: Comparison With Skin Thickness As Measured With High-Frequency Ultra-Sound. J Dermatol (Tokyo) 1985; 12: 318-324.
11) Diffey BL, Oliver RJ, Farr PM. A Portable Instrument For Quantifying Erythema Induced By Ultraviolet Radiation. Br J Dermatol 1984; 111: 663-672.
Key words: Alopecia Areata, Alopecia Totalis, Viviscal