Ann Dermatol.  2013 Nov;25(4):471-474. 10.5021/ad.2013.25.4.471.

Early Intervention with High-Dose Steroid Pulse Therapy Prolongs Disease-Free Interval of Severe Alopecia Areata: A Retrospective Study

• Yang CC
• Lee CT
• Hsu CK
• Lee YP
• Wong TW
• Chao SC
• Lee JY
• Sheu HM
• Chen W

• KMID: 2265060
• DOI: http://doi.org/10.5021/ad.2013.25.4.471

Abstract

BACKGROUND
Spontaneous recovery of severe alopecia areata is rare and the condition is difficult to treat.
OBJECTIVE
The aim of this study is to investigate and compare the effects and safety of steroid pulse therapy between oral and intravenous administrations between 1999 and 2010 at the Department of Dermatology, National Cheng Kung University Hospital.
METHODS
Data were retrospectively retrieved. A satisfactory response was defined as more than 75% hair regrowth in the balding area.
RESULTS
A total of 85 patients with more than 50% hair loss were identified and treated, with an overall satisfactory response rate of 51.8%. The mean follow-up time was 37.6 months, with a relapse rate of 22.7%. Patients with alopecia areata (hereafter, AA) of recent onset within one year showed higher response rates (p<0.001) and lower relapse rates compared to patients with AA persisting for more than 1 year. Further, even in patients with alopecia totalis, alopecia universalis or ophiasis type, early treatment resulted in a satisfactory response rate of 47% among the treated patients. In general, oral therapy was as effective and well-tolerated as intravenous therapy.
CONCLUSION
The response rate is determined by disease severity and time of intervention, not by the administration form of steroid pulse therapy. Oral steroid pulse therapy can be considered as the first-line treatment for patients with severe AA of recent onset within one year.

Keyword

Alopecia areata; Corticosteroids; Pulse drug therapy; Treatment

MeSH Terms

Administration, Intravenous
Adrenal Cortex Hormones
Alopecia Areata*
Alopecia*
Dermatology
Early Intervention (Education)*
Follow-Up Studies
Hair
Humans
Pulse Therapy, Drug
Recurrence
Retrospective Studies*
Adrenal Cortex Hormones

Figure

• 

  Fig. 1 Photography demonstrating the effect of oral steroid pulse therapy. (A) Severe alopecia areata in a 33-year-old male patient with only a small amount of hair on the occipital scalp (not shown) for 3 months. (B) Satisfactory regrowth of scalp hair was noted 6 months after initiating oral prednisolone pulse therapy at a dose of 5 mg/kg per day every 2 weeks for a total of 5 sessions. (C) Another 21-year-old male patient with alopecia totalis for 2 months. (D) Complete hair regrowth was noted 12 months after one session of oral prednisolone pulse therapy at a dose of 5 mg/kg per day for a total of 3 days.

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