High‐dose pulsed corticosteroid therapy combined with methotrexate for severe alopecia areata of childhood

Abstract

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).

Azathioprine in combination with methotrexate: a therapeutic alternative in severe and recalcitrant forms of alopecia areata?

“…Previous studies described the efficacy of MTX, alone or in combination with corticosteroids, for the treatment of extensive forms of AA with successful response in both adult and paediatric populations. [4][5][6] Other studies tested AZA alone 7,8 in the treatment of AA, with clinical outcomes and follow-up almost comparable to our experience. The association AZA plus MTX has never been experienced before in the treatment of severe forms of AA; however, the therapeutic concept has already been described by our group in adult patients with severe atopic dermatitis.…”

“…Demographic and clinical characteristics at baseline, at 6 months and at 1 year are shown in Table 1. The simplified global score (SGS) 5 was assessed at 6 months and at Letters to the Editor 1 year of treatment, corresponding to 0 = no change, 1 ≤ 50%, 2 ≥ 50% to 99% and 3 = 100% hair regrowth. After 6 months of treatment, hair regrowth was recorded in 10 patients (55.5%), with SGS = 1 in eight patients and SGS = 2 in two patients.…”

“…This innovative and low-cost approach could be considered in the therapeutic arsenal against refractory forms of AA, in the context of the clinical development of JAK1 and JAK2 inhibitors in the treatment of severe AA. [3][4][5][6][7][8][9][10]…”

Methotrexate in the treatment of paediatric alopecia areata: Retrospective case series and updated meta‐analysis

“…A recent systematic review and meta‐analysis demonstrated reasonable effectiveness for MTX in patients with severe AA, with subgroup analysis demonstrating no difference in adverse effects in adults versus paediatric cases. However, there have only been a small number of studies reporting outcomes for MTX in childhood AA . In addition, these studies were all performed in American or European patient cohorts.…”

Is methotrexate an effective and safe treatment for maintaining hair regrowth in people with alopecia totalis? A Critically Appraised Topic

“…Many are brief, with scant or absent methodology and lack of follow‐up data. No studies mention blinding of outcome assessment and only one study utilized two separate assessors . The risk of publication bias is likely to be significant in such case series.…”