Pulse Corticosteroid Therapy for Alopecia Areata: Study of 139 Patients

Abstract

Background/Aim: Recent reports of pulse corticosteroid therapy for alopecia areata (AA) show its efficacy for patients with a history of ≤1 year but not for recalcitrant cases or alopecia totalis/universalis. The purpose of this study was to evaluate the efficacy and safety of pulse corticosteroid therapy for recent-onset AA patients. Method: A total of 139 severe AA patients aged >15 years were included in this study. The duration from the onset of active hair loss was within 12 months for 125 (89.9%) of those patients. Results: Of the patients, 72.7% had hair loss on >50% of their scalp area. Among the recent-onset group (duration of AA ≤6 months), 59.4% were good responders (>75% regrowth of alopecia lesions), while 15.8% with >6 months duration showed a good response. Recent-onset AA patients with less severe disease (≤50% hair loss) responded at a rate of 88.0%, but only 21.4% of recent-onset patients with 100% hair loss responded. No serious adverse effects were observed.

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

“…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]. …”

“…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).…”

An observational study of alopecia areata in Sri Lankan adult patients

“…Of the 203 patients treated with intralesional steroids, only 6% had significant local side effects. Studies report that combination therapy of oral dexamethasone mini pulse and topical minoxidil lotion is effective on severe recalcitrant AA [11]. These were well tolerated in our patients, only one patient developed side effects with systemic steroids, and one patient developed irritation with topical minoxidil.…”

“…Local steroids (topical or intralesional) are effective in treatment of localised AA [10]. Systemic steroids and topical minoxidil lotionare effective in severe disease [11,12].…”

Significance of Dermoscopy in Acute Diffuse and Total Alopecia of the Female Scalp: Review of Twenty Cases

“…We diagnosed AA by a precedence of typical patchy AA, later progression to alopecia totalis or scalp biopsy findings corresponding to AA. Then, we extracted the cases corresponding to ADTAFS by the following criteria: (1) rapid progression evidenced by an increase in total hair loss of more than 20% over the month prior to the first visit, (2) showing no apparently circumscribed hair loss at the first visit and (3) favorable prognosis evidenced by more than 75% regrowth of alopecia within 9 months after oral or intravenous corticosteroid pulse therapy (oral prednisolone 30 mg/day on 3 consecutive days for 2 weeks × 3 cools or intravenous methylprednisolone 500 mg/day on 3 consecutive days) or application of topical corticosteroid [16]. The age of the ADTAFS patients varied from 15 to 57 years, and the median age was 32.5 years.…”