Combined intravenous pulse and topical corticosteroid therapy for severe alopecia areata in children: Comparison of two regimens

Abstract

There is no universally accepted treatment for severe pediatric alopecia areata (AA). This prospective study comprised 73 patients (aged 1–18 years) with severe AA (>30% of scalp surface area): 37 received 1‐day intravenous dexamethasone pulses (1‐DP) and 36 received 3‐day pulses (3‐DP), monthly, for 6–12 months. Also, all patients applied topical clobetasol propionate under plastic wrap occlusion. Patients achieving >50% regrowth were considered good responders (GR). All patients reached short term, while 65/73 were available for the long‐term follow‐up (mean 33.3 ± 15.3 vs. 27.7 ± 14.3 months, 1‐DP and 3‐DP, respectively). Relapses during therapy were more frequent in 1‐DP group. 3‐DP patients were more frequently GR in comparison with 1‐DP. 3‐DP patients with disease duration <6 months had better outcomes. Patients without Hashimoto thyroiditis (HT) had 9.8‐fold higher chance of being GR in comparison with HT patients. The best results were achieved in AA plurifocalis (AAP). No patient had severe short‐term side‐effects. At the long‐term follow‐up, 67% of 3‐DP patients had stable results. Only 14.2% AAP patients experienced relapses. Patients had no long‐term side‐effects. 3‐DP were more efficacious than 1‐DP. Short disease duration and no HT were good prognostic factors. 3‐DP protocol is well‐tolerated, with beneficial effects and long‐lasting results in severe pediatric AA.

Alopecia Areata and Dexamethasone Mini-Pulse Therapy, A Prospective Cohort: Real World Evidence and Factors Related to Successful Response

“…On the other hand, in line with our results, the early age of onset has been previously associated with a more aggressive course [ 29 ]. Regarding the presence of hypothyroidism, similar results have been found in other studies [ 30 ], with patients with hypothyroidism having poorer responses in comparison to patients without the disorder. In light of our results, the use of dexamethasone in the treatment of these patients should be avoided or, at least, should be evaluated early to detect a lack of efficacy before the appearance of undesirable adverse effects.…”

Alopecia areata – Aktuelles Verständnis und Management

“…In einer placebokontrollierten Studie zur oralen PT wurde bei 40 % der mit Prednisolon behandelten Gruppe ein signifikantes Ansprechen und bei 25 % ein Rückfall innerhalb von drei Monaten festgestellt [116]. Obwohl in der Literatur keine schwerwiegenden oder langfristigen Nebenwirkungen der PT berichtet wurden, auch nicht bei Kindern [108,[117][118][119], stellen die bekannten Nebenwirkungen von Kortikosteroiden ein Hindernis für ihre breitere und langfristige Anwendung bei AA dar.…”

Tofacitinib for Treatment of Alopecia Areata: Real-world Evidence and Factors Associated with Therapeutic Response

“…Oral tofacitinib is an effective treatment for severe cases of AA that failed to respond to other therapies, leading to progressive and high rates of SALT reduction up to 12 months. The response rates may be higher than those achieved by corticosteroids ( 3 ). Moreover, effectiveness does not appear to be related to sex, age of onset, duration of the disease, or treatment combination with oral minoxidil.…”

“…A wide variety of treatments have been used in management of AA ( 2 ). Severe and extensive cases of AA, are commonly treated with systemic drugs, including corticosteroids ( 3 ) or immunosuppressive agents ( 4 ). However, lack of response and side-effects are often associated with these treatments.…”