Ann Dermatol.  2017 Jun;29(3):263-267. 10.5021/ad.2017.29.3.263.

Low-Dose Systemic Methotrexate Therapy for Recalcitrant Alopecia Areata

Affiliations
  • 1Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea. resina20@cnu.ac.kr
  • 2Clinical Trials Center, Chungnam National University Hospital, Daejeon, Korea.

Abstract

BACKGROUND
Alopecia areata (AA) is an autoimmune skin disease difficult to manage and treat. The pathogenesis of AA features a T-cell-associated autoimmune process, and systemic immunosuppressive therapy is prescribed widely for AA.
OBJECTIVE
To evaluate the efficacy and tolerance of systemic low-dose methotrexate (LD-MTX) therapy in treatment of recalcitrant AA multiplex.
METHODS
In a retrospective, non-controlled study, we evaluated 29 patients with recalcitrant AA treated with LD-MTX and assessed the therapeutic response according to severity of disease, disease duration, cumulative dose of MTX, and drug safety.
RESULTS
MTX was administered twice weekly, and the mean maximum weekly dose was 14.48 mg. The response was A5 (regrowth=100.0%) in 14 (48.3%) patients and A4 (regrowth of 75%~90%) in 12 (41.4%) patients. Three patients had poor response to LD-MTX treatment (A2: n=2 [6.9%], A1: n=1 [3.4%]). All three of the patients showing a poor response had disease durations exceeding 24 months. Relapse was observed in 31% of patients with more than 75% regrowth. Common side-effects were elevated liver enzyme levels and gastrointestinal discomfort.
CONCLUSION
LD-MTX appears to be an effective and well-tolerated treatment for recalcitrant AA multiplex.

Keyword

Alopecia areata; Autoimmune; Methotrexate; Recalcitrant; Remission

MeSH Terms

Alopecia Areata*
Alopecia*
Humans
Liver
Methotrexate*
Recurrence
Retrospective Studies
Skin Diseases
Methotrexate

Figure

  • Fig. 1 Clinical response of low-dose methotrexate (LD-MTX) treatment. Baseline features of patients (A, C, E) and clinical response to LD-MTX treatment (B, D, F). A5 responses were seen in a (A, B) 44-year-old S4 male, (C, D) 47-year-old S2 male, and (E, F) 47-year-old S3 female.


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