Combined intravenous pulse and topical corticosteroid therapy for severe alopecia areata in children: Comparison of two regimens

Pediatric pulse dose corticosteroid therapy dosing and administration in the treatment of alopecia areata: A review of literature

BACKGROUND

The use of pulse dose corticosteroid therapy (PDCT) in children for treatment of alopecia areata (AA) has been reported, but dosing regimens are not well-established. We aim to evaluate the available literature regarding the utilization and various dosing regimens of PDCT, as well as associated side effects, in the treatment of AA in children.

METHODS

We performed a systematic review of studies describing the use of PDCT for the treatment of AA in children.

RESULTS

Eight relevant studies were identified, five of which administered the treatment intravenously (IV) and three of which administered the treatment orally. Protocols with IV administration included two studies which used IV dexamethasone at 1.5 mg/kg/day for 1-3 days monthly for a maximum of 12 cycles and three studies used IV methylprednisolone 8-30 mg/kg/day for 1-3 days monthly for a maximum of 3-10 cycles. The three protocols with oral administration included variable doses of prednisolone at variable intervals and cycle lengths, betamethasone and dexamethasone at a prednisolone equivalent of 5 mg/kg, and methylprednisolone 15 mg/kg for 3 days bimonthly for 12 cycles. In these studies, PDCT was generally well-tolerated and resulted in improvement of the AA.

CONCLUSION

PDCT was found to be well-tolerated with few serious side effects reported. It appears to be beneficial early in disease course, especially for those with multifocal AA.

Tofacitinib for Treatment of Alopecia Areata: Real-world Evidence and Factors Associated with Therapeutic Response

Abstract is missing (Short communication)

Alopecia Areata and Dexamethasone Mini-Pulse Therapy, A Prospective Cohort: Real World Evidence and Factors Related to Successful Response

The mini-pulse oral corticosteroids treatment for alopecia areata (AA) is an accessible treatment whose efficacy and adverse effects have not yet been properly described. The objective of the study was to assess the effectiveness and safety of the mini-pulse oral corticosteroids treatment in patients with AA, and to explore potential factors associated to the response in a real-world setting. An observational study of a prospective cohort to assess the effectiveness and safety of a mini-pulse dexamethasone treatment in patients with AA, who failed to improve with topical therapies, was performed. A SALT II score and other clinical and safety variables were recorded at baseline, 3, 6, 9, and 12 months. An overall significant and progressive decrease of the SALT score was found during treatment: SALT-50 response was achieved after 9 months in 51.8% of the patients. Hypothyroidism and early age of onset were predictors of the lack of response to treatment. The treatment combination with oral minoxidil showed no effect on the SALT score reduction. Dexamethasone daily and cumulative dose were associated with a higher percentage of side effects. To conclude, the mini-pulse oral corticosteroids treatment is an effective treatment for AA, although patients with an early onset of the disease and hypothyroidism may not benefit.

Alopecia areata - Current understanding and management

Alopecia areata (AA) is a chronic, immune-mediated disease characterized by acute or chronic non-scarring hair loss, with a heterogeneity in clinical manifestations ranging from patchy hair loss to complete scalp and body hair loss. An overview of the up-to-date pathophysiology and the underlying signaling pathways involved in AA together with diagnostic and therapeutic recommendations will be provided. Current treatments, including topical, systemic and injectable interventions show varying response and frequent relapses reflecting the unmet clinical need. Thus, the new emerging concepts and therapeutic approaches, including Janus kinase inhibitors are eagerly awaited. Traditional and emerging therapies of AA will be discussed, in order to provide physicians with guidance for AA management. Since the latter is so challenging and often tends to take a chronic course, it can have an enormous psychosocial burden on patients, compromising their quality of life and often causing depression and anxiety. Therefore, the psychosocial aspects of the disease need to be evaluated and addressed, in order to implement appropriate psychological support when needed.