A comparison of the efficacy, relapse rate and side effects among three modalities of systemic corticosteroid therapy for alopecia areata.
BACKGROUND
Systemic corticosteroids are one of the most commonly used therapeutic modalities for patients with extensive alopecia areata (AA), although they entail several drawbacks.


OBJECTIVE
To determine the best modality for systemic corticosteroid use in terms of their efficacy, relapse rate, and side effects.


METHODS
Fifty-one patients with single or multiple AA (AA/multiplex) and 38 patients with alopecia totalis or AA universalis (AA totalis/universalis) were enrolled in this open study. They were randomly divided into three groups depending on the time of their initial visit. They were administered (1) oral dexamethasone (Dex) 0.5 mg/day for 6 months (Dex group), (2) intramuscular triamcinolone acetonide (imTA) 40 mg once a month for 6 months followed by 40 mg once every 1.5 months for 1 year (imTA group), and (3) pulse therapy (PT) using oral predonine 80 mg for 3 consecutive days once every 3 months (PT group). After the treatment, each treatment modality was evaluated by the response rate, relapse rate, and side effect profile.


RESULTS
The response rate of AA/multiplex was significantly better in the imTA group than in the Dex group. The overall relapse rate and that of AA totalis/universalis were significantly better in the PT group than in the Dex group. Dysmenorrhea was the most common and problematic side effect. Impairment of the adrenocortical reserve was seen in 7% of the PT group and 23% of the imTA group, which was recovered without any further medical treatment.


CONCLUSIONS
imTA or pulse therapy is effective for AA and has an acceptable level of side effects. The development of a new strategy to reduce the relapse rate is needed.
Kurosawa
Masahiro
M
Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Nakagawa
Satoshi
S
Mizuashi
Masato
M
Sasaki
Yoshinori
Y
Kawamura
Maki
M
Saito
Makiko
M
Aiba
Setsuya
S
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000506:Alopecia Areata / Q000188:drug therapy*; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006197:Hair / Q000187:drug effects / Q000254:growth & development; D006801:Humans; D007273:Injections, Intramuscular; D007564:Japan; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D017211:Treatment Failure; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000009:adverse effects / Q000627:therapeutic use*
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D011239:Prednisolone; D014222:Triamcinolone Acetonide