Background: Therapy for alopecia areata (AA) in pediatric patients is challenging and unstandardized. Common treatments for alopecia include topical agents, triamcinolone injections, and systemic agents. Treatment using systemic agents in children is controversial due to possible negative side effects and the need for long term therapy because of potential relapse after cessation. The purpose of this study was to evaluate the efficacy and safety of methotrexate therapy for the treatment of AA in pediatric patients. This medication is affordable and routinely used in children for other chronic conditions.Methods: This retrospective chart review included patients treated with methotrexate for AA who were managed by the Dermatology Section at the Children's Hospital of Philadelphia between 2015 and 2018. The following data was extracted from patients' charts: severity of disease measured by Severity of Alopecia Tool (SALT) scores, duration of treatment course, side effects, age, race, and sex.Results: 27 pediatric patients treated with methotrexate were included in the study. There was a statistically significant decrease in SALT score between initial SALT score and score at 12-15 months, but not between initial score and SALT at 6-9 months. Mood changes and gastrointestinal discomfort were the most commonly reported adverse effects. Conclusion:Our study demonstrates that patients treated with methotrexate had a statistically significant improvement in SALT scores at 12-15 months, despite the SALT scores showing no improvement at 6-9 months. This suggests the results of methotrexate may be delayed, but that the mediation is still effective and safe. Check for updatesAdditionally, systemic therapies include oral corticosteroids, methotrexate, biologics, and off label JAK kinase inhibitors such as tofacitinib or biologics like dupilumab, currently in trial as a treatment for AA [7,8].An Australian consensus created guidelines to direct the management of AA. This consensus determined that the mainstay of therapy for most presentations of alopecia are corticosteroid injections for both adults and topical corticosteroids or immunotherapies for children. However,
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