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High-dose pulsed corticosteroid therapy combined with methotrexate for severe alopecia areata of childhood EditorAlopecia areata (AA) in childhood can run a chronic course and worsen over time. 1 Spontaneous hair regrowth is rarely appreciated in chronic severe AA. [2][3][4] Our centre described the ineffective use of high-dose pulsed corticosteroid therapy (HDPCT) in the long term. 1 Methotrexate (MTX) as a maintenance therapy following HDPCT showed some success in adults. 5 Although the evidence for using either drug individually was weak, 6 the combination of using both was not well studied.From 2010 to 2015, 14 paediatric cases of alopecia totalis (AAT) and universalis (AAU) who failed topical therapy underwent treatment consisting of 3 days of intravenous methylprednisolone at 10 mg/kg/day for three consecutive months followed by MTX at 0.2 mg/kg/day. Evaluation of photographs and clinical documentation before starting treatment, at 3 months then 6 monthly were performed by two dermatologists. Hair regrowth was defined as A0 = no change, A1 = 1-24%, A2 = 25-49%, A3 = 50-74%, A4 = 75-99%, A5 = 100%. 7 A further simplified global score was classified as 0 = no change, 1 ≤ 50%, 2 ≥ 50% to 99%, 3 = 100%. Good and poor responders to treatment were defined by hair regrowth of ≥50% (score of 2 or 3) and <50% (score 0 or 1), respectively.The mean age of AA onset was 5.6 years. The median age of starting HDPCT:MTX was 14 years. There were 6 good responders (Table 1). 4 showed good responses by 6 months of treatment. Two good responders who stopped MTX had sustained *6/F AU 11 13 2 3 1.5No., Number; AU, alopecia universalis; AT, alopecia totalis; HDPCT, high-dose pulsed corticosteroids (intravenous methylprednisolone); MTX, methotrexate; *, best responder (see Fig. 1).

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