Methotrexate in alopecia areata: A report of three cases

Batalla, Ana; Flórez, Ángeles; Abalde, Teresa; Vázquez‐Veiga, Hugo

doi:10.4103/ijt.ijt_67_16

Cited by 10 publications

(12 citation statements)

References 10 publications

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“…Table summarises the six studies to date which have evaluated the efficacy of MTX in 54 paediatric AA cases . Successful outcome ranged from 38.5% to 70%.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

2019

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Background/Objectives: There is a paucity of data regarding the efficacy and safety of methotrexate (MTX) in childhood alopecia areata (AA), particularly in an Australasian cohort. We aimed to assess the efficacy and safety of MTX in childhood AA based on our institutional experience.Methods: A retrospective chart review was performed from patients treated by a consultant dermatologist. Consecutive children with AA treated with MTX seen between 2010 and 2019 were analysed. A meta-analysis of proportions was conducted for response rates, recurrences and complications of reported data in the literature.Results: Overall, 7 cases (70%) achieved treatment success whilst on MTX treatment. The remainder of cases were considered treatment failures. These were three children with partial regrowth with persistent patches on the scalp. No serious side effects were reported. Two cases experienced nausea or vomiting after MTX administration which was transient. Pooled meta-analysis showed success rates of 49.7%, recurrences in 30% and side effects in 15.7% of cases. Conclusions:Overall, this study shows that methotrexate for paediatric AA in an Australian context was beneficial for the majority of cases assessed and had minimal adverse effects. We propose that such treatment should not be ruled out in the paediatric population.

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“…Table summarises the six studies to date which have evaluated the efficacy of MTX in 54 paediatric AA cases . Successful outcome ranged from 38.5% to 70%.…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2019

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“…However, it was also reported to be effective in monotherapy with the response rate of 100% (10/10). [48][49][50] The adverse effects of systemic methotrexate in children with alopecia areata included nausea, vomiting, abdominal discomfort, abnormal liver function test results, neutropenia, migraine, leg weakness and tooth sensitivity. [48][49][50][51][52][53] Topical minoxidil [the highest level of evidence: III; the total number of patients: 9; response rate in monotherapy: 44% (4/9); global response rate: 44% (4/9); relapse rate: 0% (0/ 1)]…”

Section: Resultsmentioning

confidence: 99%

“…In paediatric alopecia areata, methotrexate (2.5–25 mg/week or 0.2 mg/kg/day) was usually used in combination with glucocorticosteroids. However, it was also reported to be effective in monotherapy with the response rate of 100% (10/10) 48‐50 . The adverse effects of systemic methotrexate in children with alopecia areata included nausea, vomiting, abdominal discomfort, abnormal liver function test results, neutropenia, migraine, leg weakness and tooth sensitivity 48‐53 …”

Section: Resultsmentioning

confidence: 99%

“…However, long-term follow-up was not available in the majority of studies concerning the usefulness of methotrexate in paediatric alopecia areata. 48,49,53 Minoxidil (2,4-diamino-6-piperidinopyrimidine-3-oxide) was first described as a treatment option for alopecia areata in 1982. 73 According to Australian experts, topical minoxidil should be one of the first-line therapeutic options in paediatric alopecia areata.…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic management in paediatric alopecia areata: A systematic review

Waśkiel‐Burnat

Kołodziejak

Sikora

et al. 2021

Acad Dermatol Venereol

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Alopecia areata is the third most common cause of dermatology consultations in children but the treatment of paediatric alopecia areata remains challenging. A systematic review of the literature about the treatment of alopecia areata in children (≤18 years old) was performed on 11 May 2020 by searching the PubMed, Scopus and EBSCO databases.The terms used for the search were: 'alopecia areata', 'alopecia totalis' or 'alopecia universalis' combined with 'paediatric', 'children' or 'childhood'. A total of 89 articles were included in final evaluation. The most commonly assessed treatment options in paediatric alopecia areata were topical immunotherapy (response rate in monotherapy: 54%; 187/ 345) intralesional glucocorticosteroids (75%; 211/280), systemic glucocorticosteroids (73%; 102/140), and anthralin (42%; 31/74). Topical glucocorticosteroids (81%; 35/43), systemic Janus kinase (JAK) inhibitors (90%; 27/30), topical calcineurin inhibitors (42%; 8/19), topical JAK inhibitors (65%; 11/17), PUVA therapy (56%; 9/16) and 308-nm excimer laser (77%; 10/13) were also evaluated. Additionally, evaluation in smaller numbers of paediatric patients included methotrexate (100%; 10/10), topical minoxidil (44%; 4/9) and cyclosporine (83%; 5/6). There were limited data considering children with alopecia areata treated with azathioprine, hydroxychloroquine, topical sildenafil, topical prostaglandin analogues, fractional carbon dioxide laser, leflunomide, mesalazine, apremilast, dupilumab, ustekinumab, efalizumab, botulinum toxin, and compound glycyrrhizin. On the basis of the limited data available glucocorticosteroids (systemic, intralesional or topical) and JAK inhibitors (systemic or topical) may be considered the best documented and most effective treatment options in alopecia areata in children. There are no sufficient paediatric data to compare treatment safety and relapse rates in these therapeutic modalities.

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