Treatment of extensive alopecia areata with oral prednisolone mini-pulse regimen
Keywords:
Alopecia areata, extensive alopecia areata, alopecia totalis, mini-pulse therapy, oral steroidsAbstract
Background Systemic steroids in mini doses have been reported effective in the treatment of alopecia areata. Objective To evaluate the efficacy of oral prednisolone in mini pulse regimen in the treatment of severe forms of alopecia areata. Patients and methods This open uncontrolled study was conducted at the Department of Dermatology and Medicine,LiaquatUniversityHospital,Hyderabad from June, 2007 to July, 2008. All adult patients of both genders not receiving any topical or systemic treatment were enrolled in study. Non-probability convenience technique was used for sampling. After recording personal data and short history regarding the onset, duration and treatment received; thorough cutaneous and systemic examination was done. The patients were assessed clinically and with photographs at all visits. All patients received 30 mg oral prednisolone for 3 consecutive days in a week for 6 months. They were assessed for response and side effects at monthly intervals. The post treatment follow-up was done for 6 months. The findings were recorded on close ended proforma. The data were analyzed using SPSS software version 11.0. Results Fourteen male and 8 female patients aged between 16 and 40 years (mean 25.5 years) were enrolled for study. The duration of the disease at the time of presentation was from 6 months to 10 years (mean 3.6 years). Fourteen patients had extensive alopecia of scalp, 6 alopecia totalis while 2 alopecia universalis. Eight (15.7%) patients showed excellent response and 5 (9.8%) good response. The response was satisfactory in 7 (13.7%) and unsatisfactory in 2 (3.9%) patients. Conclusion Low dose steroids in mini-pulse regimen are an effective treatment modality for treating AA.ÂReferences
Norris D. Alopecia areata: current state of knowledge. J Am Acad Dermatol 2004; 51 (Suppl): S16-S17
Sharma VK, Dawn G, Kumar B. Profile of alopecia areata in northern India. Int J Dermatol 1996; 35: 22- 7.
McDonagh AJG, Tazi-Ahnini R. Epidemiology and genetics of alopecia areata. Clin Exp Dermatol 2002; 27: 405-9.
Alexis AF, Dudda-Subramanya R, Sinha AA. Alopecia areata: autoimmune basis of hair loss. Eur J Dermatol 2004; 14: 364– 70.
Grandolfo M, Biscazzi AM, Pipoli M. Alopecia areata and autoimmunity. G Ital Dermatol Venereol. 2008; 143: 277-81.
Madani S, Shapiro J. Alopecia areata update. J Am Acad Dermatol 2000; 42 : 549-66.
Kar BR, Handa S, Dogra S, Kumar B. Placebo-controlled oral pulse prednisolone therapy in alopecia areata. J Am Acad Dermatol 2005; 52: 287-90.
Khaitan BK, Mittak R, Verma KK. Extensive alopecia areata treated with betamethasone oral mini-pulse therapy: An open uncontrolled study. Indian J Dermatol Venerol Leprol 2004; 70: 350-3.
Moreno JC, Ocana MS, Velez A. Cyclosporin A and alopecia areata. J Eur Acad Dermatol Venereol 2002; 16: 417-8.
Joly P. The use of methotrexate alone or in combination with low doses of oral corticosteroids in the treatment of alopecia totalis or universalis. J Am Acad Dermatol 2006; 55: 632-6.
Heffernan MP, Hurley MY, Martin KS et al. Alefacept for alopecia areata. Arch Dermatol 2005; 141: 1513-6.
McEleeve KJ, Rushton DH, Trachy R, Oliver RF. Topical FK506: a potent immunotherapy for alopecia areata? Studies using the Dundee experimental bald rat model. Br J Dermatol 1997; 137: 491-7.
Assouly P, Reygagne P, Jouanique C et al. Intravenous pulse methylprednisolone therapy for severe alopecia areata: an open study of 66 patients. Ann Dermatol Venereol 2003; 130: 326-30.
Kurosawa M, Nakagawa S, Mizuashi M et al. A comparison of the efficacy, relapse rate and side effects among three modalities of systemic corticosteroid therapy for alopecia areata. Dermatology 2006; 212: 361-5.
Pasricha JS, Kumrah L. Alopecia totalis treated with oral mini-pulse (OMP) therapy with betamethasone. Indian J Dermatol Venereol Leprol 1996; 62: 106-9.
Sharma VK, Gupta S. Twice weekly 5 mg dexamethasone oral pulse in the treatment of extensive alopecia areata. J Dermatol 1999; 26: 562-5.
Vijayakumar M, Thappa DM. Dexamethasone pulse therapy for extensive alopecia areata: To use or not to use. Indian J Dermatol Venereol Leprol 2002; 68: 52-3.
Seyrafi H, Akhiani M, Abbasi H et al. Evaluation of the profile of alopecia areata and the prevalence of thyroid function test abnormalities and serum autoantibodies in Iranian patients. BMC Dermatol 2005; 5: 11
Alabdulkareem AS, Abahussein AA, Okoro A. Severe alopecia areata treated with systemic corticosteroids. Inl J Dermatol 1998; 37: 622-4.
Nakajima T, Inui S, Itami S. Pulse corticosteroid therapy for alopecia areata: study of 139 patients. Dermatology 2007; 215: 320-4.
Tosti A, Bellavista S, Iorizzo M: Alopecia areata: a long-term follow-up study of 191 patients. J Am Acad Dermatol 2006; 55: 438-41.