Combined oral pulse and topical corticosteroid therapy for severe alopecia areata in children: a long-term follow-up study

Abstract

There are no widely accepted therapy protocols for severe alopecia areata (AA). We treated 65 children/adolescents with AA affecting >30% of scalp. Fourty-three percent of patients had AA plurifocalis (AAP). Fifty-seven percent had AA subtotalis (AAS), AAP+ophiasis (AAP+OPH), and alopecia totalis/universalis (AT/AU). Long-term follow-up (median 96 months) data were available for 69% of patients. Oral dexamethasone (prednisolone 5 mg/kg equivalent) was given once in 4 weeks. Patients received 6, 9, or 12 pulses. Clobetasol propionate 0.05% ointment under plastic wrap occlusion was applied 6 days a week. Hair growth was assessed on a scale ranging 0-100% of regrowth in individual AA lesions. Regrowth >50% was considered good response. Six to twelve months months after the therapy, 56.9% of patients had >75% of hair regrowth. In AAP, 65.5% had complete regrowth. 61.5% of all patients were considered good responders. Significantly, higher percentage of good responders was found in AA lasting ≤12 months. No patients had serious side effects. There was no change in stability of the hair status at the long-term follow-up. Most AA patients had beneficial effects with this protocol. Best results were in AAP and AAP+OPH. Combined topical and oral pulse corticosteroid therapy of AA in children shows long-lasting results, without serious side effects.

Alopecia Areata. Current situation and perspectives

“…57,66 In children, such effects could impact on their growth and development. 20,64 Therefore, the patient with AA should receive both medical and psychological counseling. The Physician should explain to the patient or patient's parents (when they are children), the unpredictable nature of the condition, the possible course, the treatments available and the success or failure that these may have.…”

“…Although corticosteroid pulse therapy has shown lower adverse effects at low doses. 63,64 Methotrexate is being evaluated in children with AT or AU and prednisolone has been recommended in some cases.…”

Alopecia areata: a long‐term follow‐up study of 104 patients

“…Systemic corticosteroid therapy in AA was first reported in 1952 by Dillaha and Rothman and steroid pulse therapy by Burton and Shuster in 1975 . The use of contact irritants and steroid‐sparing agents started in the early 1990s . These therapies could have influenced the disease course and long‐term prognosis.…”

Review of treatment for alopecia totalis and alopecia universalis

“…The efficacy of systemic steroids was examined in 13 studies . No studies were found that examined intralesional steroids, likely the result of the extensive nature of AT and AU.…”