Methotrexate for the treatment of pediatric alopecia areata

Landis, Erin; Pichardo-Geisinger, Rita

doi:10.1080/09546634.2017.1341608

Cited by 25 publications

(31 citation statements)

References 8 publications

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Section: Discussionmentioning

confidence: 99%

“…Nevertheless, a single systematic review reports that patients who responded to treatment had low relapse rates, suggesting that in patients with good prognostic factors pulse corticosteroid therapy may be beneficial (Shreberk-Hassidim, Ramot, Gilula, & Zlotogorski, 2016). The frequency of relapses could be potentially reduced with the addition of methotrexate, but more controlled studies are necessary (Landis & Pichardo-Geisinger, 2018;Lucas et al, 2016) AA is a chronic, relapsing autoimmune disease that, if treated with systemic corticosteroids, requires a reasonable cumulative dose for the suppression of inflammation and for hair regrowth initiation. 3-DP were more effective than 1-DP in the treatment of severe pediatric AA.…”

Section: Comparison Of 3-dp Group To the Available Literaturementioning

confidence: 99%

See 1 more Smart Citation

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

Lalošević¹,

Gajić-Veljić

Bonači-Nikolić

et al. 2019

Dermatologic Therapy

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Comparison Of 3-dp Group To the Available Literaturementioning

confidence: 99%

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

Lalošević¹,

Gajić-Veljić

Bonači-Nikolić

et al. 2019

Dermatologic Therapy

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“…A recent systematic review and meta‐analysis demonstrated reasonable effectiveness for MTX in patients with severe AA, with subgroup analysis demonstrating no difference in adverse effects in adults versus paediatric cases. However, there have only been a small number of studies reporting outcomes for MTX in childhood AA . In addition, these studies were all performed in American or European patient cohorts.…”

Section: Introductionmentioning

confidence: 99%

Methotrexate in the treatment of paediatric alopecia areata: Retrospective case series and updated meta‐analysis

2019

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Background/Objectives: There is a paucity of data regarding the efficacy and safety of methotrexate (MTX) in childhood alopecia areata (AA), particularly in an Australasian cohort. We aimed to assess the efficacy and safety of MTX in childhood AA based on our institutional experience.Methods: A retrospective chart review was performed from patients treated by a consultant dermatologist. Consecutive children with AA treated with MTX seen between 2010 and 2019 were analysed. A meta-analysis of proportions was conducted for response rates, recurrences and complications of reported data in the literature.Results: Overall, 7 cases (70%) achieved treatment success whilst on MTX treatment. The remainder of cases were considered treatment failures. These were three children with partial regrowth with persistent patches on the scalp. No serious side effects were reported. Two cases experienced nausea or vomiting after MTX administration which was transient. Pooled meta-analysis showed success rates of 49.7%, recurrences in 30% and side effects in 15.7% of cases. Conclusions:Overall, this study shows that methotrexate for paediatric AA in an Australian context was beneficial for the majority of cases assessed and had minimal adverse effects. We propose that such treatment should not be ruled out in the paediatric population.

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“…Landis and Pichardo‐Geisinger reviewed 14 children with AA treated with MTX over a 6‐year period . Severity and previous treatments were not specified.…”

Section: Critical Appraisal Of the Evidencementioning

confidence: 99%

“…Landis and Pichardo-Geisinger reviewed 14 children with AA treated with MTX over a 6-year period. 28 Severity and previous treatments were not specified. 'Good response' was noted in eight of 11 assessable children, with complete or near complete regrowth in four.…”

Section: Mtx Plus Prednisolonementioning

confidence: 99%

Is methotrexate an effective and safe treatment for maintaining hair regrowth in people with alopecia totalis? A Critically Appraised Topic

2018

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We found insufficient evidence to conclude whether MTX is useful for maintaining regrowth in extensive AA. We found some evidence to suggest that hair regrowth may be induced by MTX when used in combination with systemic corticosteroids, but it was difficult to attribute responses to any one treatment or spontaneous regrowth. Included case series were at a high risk of bias. Randomized controlled trials are needed to evaluate whether MTX alone, or in combination with corticosteroids, vs. placebo is useful for inducing and/or maintaining remission of hair regrowth. In the meantime, MTX may occasionally be considered in people with severe disease that significantly impacts on their quality of life.

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Methotrexate for the treatment of pediatric alopecia areata

Abstract: This review suggests methotrexate is a generally safe and often effective medication in pediatric alopecia areata.

Cited by 25 publications

References 8 publications

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

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

Methotrexate in the treatment of paediatric alopecia areata: Retrospective case series and updated meta‐analysis

Is methotrexate an effective and safe treatment for maintaining hair regrowth in people with alopecia totalis? A Critically Appraised Topic

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