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

Phan, Kevin; Lee, Geoffrey; Fischer, Gayle

doi:10.1111/ajd.13206

Cited by 15 publications

(23 citation statements)

References 19 publications

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“…Furthermore, the fact that most comorbidities appear to be already present at AA onset may have important clinical implications, as this may affect which therapy will be most appropriate for the individual patient. Indeed, for some patients, one drug may be contraindicated either because of co‐medication or because of the risk of exacerbation of existing conditions (as seen, for example with some psoriasis treatments and neurological disorders), 15 whereas other drugs may treat not only AA but also have beneficial effects on selected comorbidities 16,17 …”

Section: Discussionmentioning

confidence: 99%

Comorbidities of alopecia areata: a population‐based cohort study

et al. 2020

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Background. Previous studies have associated alopecia areata (AA) with a number of comorbidities. However, the timing between AA and the development of such comorbidities remains poorly understood. Aim. To examine the temporal relationship between AA diagnosis and comorbidity development in Denmark. Methods. A Danish nationwide register-based cohort study was performed on all individuals diagnosed with AA between 2007 and 2016 (n = 1843), and each patient was matched for age and sex with 10 healthy controls (HCs). Time between AA and comorbidity development was assessed, and incidence rate ratios (IRRs) were calculated to assess risk of comorbidity following initial AA diagnosis. Results. Use of antidepressant and anxiolytic drugs were mostly started prior to AA diagnosis, and these drugs were used more frequently before than after diagnosis with AA. Additional frequent comorbidities included thyroid disease, hyperlipidaemia, type 2 diabetes and asthma. Most comorbidities occurred prior to AA diagnosis; however, among those that occurred after AA diagnosis, antidepressants

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Section: Discussionmentioning

confidence: 99%

Comorbidities of alopecia areata: a population‐based cohort study

et al. 2020

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“…A recent case series on pediatric patients demonstrated a 70% success rate of methotrexate for AA with no serious side effects, other than nausea and vomiting [15]. Another study conducted on children with AA reported regrowth with methotrexate in over half of the patients studied, demonstrating that methotrexate is an effective medication in pediatric AA.…”

Section: Resultsmentioning

confidence: 97%

“…Furthermore, an updated meta-analysis for pediatric patients with AA on methotrexate showed success rates of 49.7%, recurrence rates of 30% and side effects in only 15.7% of cases. However the largest sample size encountered included 14 children [15]. Therefore, more information about this therapy should be investigated in order to make reasonable conclusions about using methotrexate in pediatric patients.…”

Section: Resultsmentioning

confidence: 99%

Retrospective Analysis of Pediatric Alopecia Areata Treated with Methotrexate

Correia¹,

Michael²,

Leslie³

2021

Dermatol Arch

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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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“…[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%

“…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%

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

Cited by 15 publications

References 19 publications

Comorbidities of alopecia areata: a population‐based cohort study

Comorbidities of alopecia areata: a population‐based cohort study

Retrospective Analysis of Pediatric Alopecia Areata Treated with Methotrexate

Therapeutic management in paediatric alopecia areata: A systematic review

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