Prognostic factors in methylprednisolone pulse therapy for alopecia areata

Abstract

Many treatments induce remission in patients with alopecia areata. Systemic steroids, for example, are effective in the treatment of severe alopecia areata but have many side-effects. To avoid these side-effects, high-dose bolus infusions of methylprednisolone have been used to treat severe alopecia areata. The purpose of this study was to evaluate the prognostic factors associated with pulse therapy and to establish proper indications for methylprednisolone pulse therapy. Seventy patients with severe alopecia areata were treated i.v. with methylprednisolone on 3 consecutive days. All of the patients had rapid and extensive hair loss with the bald area exceeding 50% of the scalp. Seventy percent of the patients showed terminal hair growth and 41.4% showed complete responses with acceptable cosmetic outcomes. The prognostic factors that influenced successful outcome were the disease duration before treatment and the type of alopecia areata. Based on these two factors, a good response was obtained for all types of alopecia areata with a duration of 3months or less before treatment and for the plurifocal type of alopecia areata with a duration of 4-6months. Methylprednisolone pulse therapy is indicated for those alopecia areata patients who fall within our good response group.

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

“…In the group described in the present study, only 3 patients had adverse effects of treatment, all of which were mild, and none required cessation of treatment. Previous studies reported similar findings [4,8,9,15,16,17,19,20,21,22]. …”

“…Be that as it may, it is likely that outcome was affected by the presence of certain factors. Short disease duration (≤6 months) was a positive prognostic factor in our study and was also associated with favorable results in previous studies in both adults [19] and children older than 12 years [20]. The better response associated with early disease may be explained by findings of fewer functional follicular structures and some follicular scarring in patients with long-standing AA [23].…”

“…In our study disease severity was found to predict therapeutic response, as patients with multifocal disease had a higher likelihood to respond to treatment than patients with ophiatic AA, AT or AU. A poor treatment response in patients with the severe variants has also been suggested by previous studies [4,10,15,17,19]. …”

“…Similarly, Sharma and Muralidhar [20] observed a better response to therapy in their group aged 3-11 years (71%) than in patients aged 12-18 years (50%). However, Im et al [19] did not find any effect of age on outcome. These epidemiological studies in large populations are needed to clarify the impact of both disease duration and age.…”

“…In 1975 Burton and Shuster [13] were the first to administer a single 2-gram intravenous methylprednisolone pulse in 22 patients with AA; however, only 3 (14%) had satisfactory hair regrowth. Thereafter, several additional studies showing a beneficial effect of pulse corticosteroids, either intravenous [4,10,14,15,16,17,18,19] or oral [9,20,21,22], were published. Four of these studies [4,14,18,20] concern a pediatric population (a total of 39 patients) (table 4).…”