Ann Dermatol.  2015 Dec;27(6):676-681. 10.5021/ad.2015.27.6.676.

Comparison of High-Dose Corticosteroid Pulse Therapy and Combination Therapy Using Oral Cyclosporine with Low-Dose Corticosteroid in Severe Alopecia Areata

• Yeo IK
• Ko EJ
• No YA
• Lim ES
• Park KY
• Li K
• Kim BJ
• Seo SJ
• Kim MN
• Hong CK

• KMID: 2157442
• DOI: http://doi.org/10.5021/ad.2015.27.6.676

Abstract

BACKGROUND
Severe alopecia areata (AA) is resistant to conventional treatment. Although systemic oral corticosteroids are an effective treatment for patients with severe AA, those drugs have many adverse effects. Corticosteroid pulse therapy has been introduced to increase therapeutic effects and reduce adverse effects. However, the treatment modality in severe AA is still controversial.
OBJECTIVE
To evaluate the effectiveness of corticosteroid pulse therapy in patients with severe AA compared with treatment with oral cyclosporine with corticosteroid.
METHODS
A total of 82 patients with severe AA were treated with corticosteroid pulse therapy, and 60 patients were treated with oral cyclosporine with corticosteroid. Both groups were retrospectively evaluated for therapeutic efficacy according to AA type and disease duration.
RESULTS
In 82 patients treated with corticosteroid pulse therapy, 53 (64.6%) were good responders (>50% hair regrowth). Patients with the plurifocal (PF) type of AA and those with a short disease duration (< or =3 months) showed better responses. In 60 patients treated with oral cyclosporine with corticosteroid, 30 (50.0%) patients showed a good response. The AA type or disease duration, however, did not significantly affect the response to treatment.
CONCLUSION
Corticosteroid pulse therapy may be a better treatment option than combination therapy in severe AA patients with the PF type.

Keyword

Alopecia areata; Cyclosporine; Pulse therapy

MeSH Terms

Adrenal Cortex Hormones
Alopecia Areata*
Alopecia*
Cyclosporine*
Hair
Humans
Retrospective Studies
Adrenal Cortex Hormones
Cyclosporine

Figure

• 

  Fig. 1 Comparison of outcomes at 6 months after corticosteroid pulse therapy according to (A) alopecia areata type and (B) duration (*p<0.05, as determined by using ANOVA with post hoc Tukey analysis). PF: plurifocal, AT: alopecia totalis, AU: alopecia universalis.

• 

  Fig. 2 Comparison of outcomes at 6 months after oral cyclosporine with low-dose corticosteroid therapy according to (A) alopecia areata type and (B) duration. PF: plurifocal, AT: alopecia totalis, AU: alopecia universalis.

• 

  Fig. 3 Comparison of therapeutic efficacy of corticosteroid pulse therapy and combination therapy of oral cyclosporine and corticosteroid (*p<0.05, as determined by using the Mann-Whitney U test). PF: plurifocal, AT: alopecia totalis, AU: alopecia universalis.

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