Interest of High-Dose Pulse Corticosteroid Therapy Combined with Methotrexate for Severe Alopecia Areata: A Retrospective Case Series

Droitcourt, Catherine; Milpied, B.; Ezzedine, Khaled; Hubiche, T.; Belin, Emilie; Akpadjan, Fabrice; Taı̈eb, Alain; Sénéschal, Julien

doi:10.1159/000339341

Cited by 38 publications

(50 citation statements)

References 28 publications

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“…Indeed, in our cohort, 4/6 patients benefited from a second course. Combining pulse therapy with low-dose oral cyclosporine [32] or methotrexate [33,34] may also increase probability of long-term remission. …”

Section: Discussionmentioning

confidence: 99%

Pulse Corticosteroid Therapy for Alopecia Areata in Children: A Retrospective Study

Friedland¹,

Tal

Lapidoth

et al. 2013

Dermatology

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Background/Objective: Alopecia areata may occur at any age, though usually before the age of 20 years. Treatment often consists of systemic steroids administered as high-dose bolus infusions. This study sought to investigate the effectiveness and side effects of intravenous high-dose pulse corticosteroids in children with alopecia areata and to identify prognostic factors for successful treatment. Methods: Patients treated with pulse corticosteroids for alopecia areata in 2001-2008 at the day care unit of a tertiary pediatric medical center were identified by computerized file search and clinical treatment and outcome data were collected. Results: The sample included 24 children (16 female, 8 male) with a mean age of 8.5 ± 4.6 years at diagnosis; 8 (33%) had multifocal disease,10 (42%) multifocal disease with ophiasis, 4 (17%) alopecia totalis and 2 (8%) alopecia universalis. Nail involvement was noted in 9 patients (38%). Mean duration of disease was 22 ± 27 months. Patients were treated with 8 mg/kg body weight intravenous methylprednisolone on 3 consecutive days at 1-month intervals. After a mean of 5.65 ± 1.95 courses, 9 patients (38%) had a complete response, 7 (29%) a partial response and 8 (33%) no response. Of the 16 responders, 13 (81%) relapsed at 9.5 ± 12 months after the last course; 3 patients had side effects, none of which were severe. Three positive prognostic factors were identified: short disease duration (≤6 months), younger age at disease onset (<10 years) and multifocal disease (as opposed to severe, diffuse variants). Conclusions: Careful patient selection is necessary to achieve maximal benefit from pulse corticosteroid treatment for alopecia areata in children.

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Section: Discussionmentioning

confidence: 99%

Pulse Corticosteroid Therapy for Alopecia Areata in Children: A Retrospective Study

Friedland¹,

Tal

Lapidoth

et al. 2013

Dermatology

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“…Although no randomized controlled study has been found, MTX and low doses of oral corticosteroids might be an effective treatment for resistant AA, which should be evaluated in larger series [28,47,48].…”

Section: Methotrexatementioning

confidence: 99%

New Modalities in the Treatment of Refractory Alopecia Areata

Kılıç¹

2017

Hair and Scalp Disorders

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Alopecia areata (AA) is a common and complex T-cell-mediated inflammatory disorder. It may be patchy (localized), involve the entire scalp (alopecia totalis) or entire body (alopecia universalis). Alopecia totalis and universalis are often difficult to treat. Although many therapeutic options currently exist in alopecia areata, none of them are curative or preventive. Besides, none of them are approved by Food and Drug Administration (FDA). The disease unfortunately has an unpredictable course. The factors indicating a poor prognosis are the extent of hair loss at the presentation, long duration of the disease, and ophiasis pattern of hair loss. There are only a few randomized controlled studies conducted on recalcitrant AA. Recent research on immunology of hair follicle and recent developments in immunopathogenesis, together with the shared pathways of the disease with other autoimmune disorders, led investigators to focus on novel therapies that target specific immunological pathways. Herein, we will review shortly the current treatment options in recalcitrant alopecia areata based on recently published studies and then will focus on the recently developed broad-spectrum and targeted therapeutics.

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“…In combination with steroids, the different schemes that have been used are: 1) 500 mg i.v. methylprednisolone per day for 3 consecutive days, monthly, during 3 months plus MTX initiated at a dose of 12.5 mg/week and increased up to 25 mg/week [78]. 2) Prednisone at 10 or 20 mg/day and MTX at 15 mg weekly [79].…”

Section: Methotrexatementioning

confidence: 99%