Encyclopedia · immunomodulator
Cyclosporine (ciclosporin)
A transplant and psoriasis immunosuppressant that makes hair grow as a side effect and works off-label in alopecia areata, but is toxic to kidneys and blood pressure.
What it is
Cyclosporine is an oral immunosuppressant. Excess hair growth (hypertrichosis) is a common effect of cyclosporin, minoxidil and diazoxide (Tosi 1994). It is used off-label for alopecia areata alongside steroids, methotrexate and azathioprine; a European expert consensus lists these as the off-label systemic options (Rudnicka 2024). Prescription-only. It is not a pattern-baldness treatment.
How it works
For alopecia areata, the effect is immunosuppression. Separately, in cultured human scalp follicles cyclosporine lowered the Wnt-pathway brake SFRP1 in the dermal papilla, which pointed researchers to WAY-316606 (Hawkshaw 2018).
What the studies show
- A meta-analysis of mostly non-randomised studies (344 people) found a responder proportion of 73% (66% alone, 78% with systemic steroids). Recurrence was 55% on cyclosporine alone versus 28% with steroids (Husein-ElAhmed 2022).
- A Cochrane review of 63 trials found the evidence for oral prednisolone or cyclosporine versus placebo "very uncertain"; only baricitinib had high-certainty benefit (Mateos-Haro 2023).
- No evidence shows that topical cyclosporine grows hair.
How it's used in studies
- Oral, about 3 to 5 mg/kg/day in the meta-analysis above, as studied (Husein-ElAhmed 2022).
Side effects and safety
- Kidney toxicity, high blood pressure and infection risk are the main systemic risks. Excess hair on the face and body is common. It is not suitable in pregnancy without specialist advice. Relapse after stopping is common.
Bottom line
Cyclosporine is a specialist-only option for alopecia areata when JAK inhibitors are unavailable, supported by weak studies. It has no role in pattern hair loss. Discuss with a doctor.
Fun facts
- Its hairy side effect pointed researchers to a new hair-growth target (SFRP1) rather than to the drug itself (Hawkshaw 2018).
Studies 5
Husein-ElAhmed H, Steinhoff M. Efficacy and predictive factors of cyclosporine A in alopecia areata. J Dermatolog Treat. 2022
Tested: oral cyclosporine, alone or with steroids
Result: Responder proportion 73% (66% alone, 78% with steroids); recurrence 55% alone vs 28% with steroids.
Read the study ↗Mateos-Haro M et al. Treatments for alopecia areata: a network meta-analysis. Cochrane Database Syst Rev. 2023
Tested: all studied treatments
Result: Baricitinib was the only treatment with high-certainty evidence of benefit; for oral prednisolone or cyclosporine versus placebo the evidence was very uncertain.
Read the study ↗Hawkshaw NJ et al. Identifying novel strategies for treating human hair loss disorders: cyclosporine A suppresses the Wnt inhibitor, SFRP1, in the dermal papilla of human scalp hair follicles. PLoS Biol. 2018
Tested: cyclosporine A and WAY-316606
Result: Cyclosporine lowered SFRP1 and WAY-316606 reproduced the effect, boosting hair shaft production and delaying regression.
Read the study ↗Rudnicka L et al. European expert consensus statement on the systemic treatment of alopecia areata. J Eur Acad Dermatol Venereol. 2024
Tested: systemic treatments for alopecia areata
Result: Lists off-label glucocorticoids, methotrexate, cyclosporine and azathioprine alongside approved JAK inhibitors.
Read the study ↗Tosi A et al. Drug-induced hair loss and hair growth. Drug Saf. 1994
Tested: various drugs
Result: Hypertrichosis is a common effect of cyclosporin, minoxidil and diazoxide.
Read the study ↗Related
- WAY-316606A lab compound that blocks the Wnt brake SFRP1 and lengthened hair in donated human scalp follicles kept alive in a dish; it has never been tested in a person.
- BaricitinibA once-daily pill that was the first drug approved for severe alopecia areata, regrowing hair in about a third of patients while they keep taking it.
- RitlecitinibA once-daily pill approved for severe alopecia areata from age 12, which regrows hair in about 1 in 4 people by 6 months and keeps improving for years.
- JAK inhibitors and hairJanus kinase (JAK) inhibitors are pills that regrow hair in severe alopecia areata, but they are not treatments for ordinary pattern thinning.
- MinoxidilThe most widely used hair-growth treatment, available as a cheap over-the-counter lotion or foam and as a prescription tablet, with a mechanism that is still only partly understood.