Interest of high-dose pulse corticosteroid therapy combined with methotrexate for severe alopecia areata: a retrospective case series.
BACKGROUND
The combination of systemic pulse corticosteroids and methotrexate in the treatment of severe alopecia areata has never been reported.


OBJECTIVE
The objective of this work was to give arguments for the efficacy and safety of this combined treatment.


METHODS
This was a retrospective case series of patients treated with intravenous 500 mg methylprednisolone per day for 3 consecutive days monthly during 3 months plus methotrexate initiated at the end of the second pulse regimen. We reviewed all case notes of patients who received this regimen between January 1 2007 and December 1 2010.


RESULTS
Twenty patients were treated. Data on hair regrowth at month 12 were available for all patients; 14 patients were still receiving the treatment on December 1 2010, 2 patients were lost of follow-up, and 4 patients had stopped the treatment. Of the 14 patients who were still receiving the treatment regimen at month 18, 10 (10/20, 50%) had total hair regrowth and 4 (4/20, 20%) had incomplete but satisfactory hair regrowth. The treatment was well tolerated.


CONCLUSIONS
The initial treatment by pulse intravenous corticosteroids may influence the overall response. This approach should be evaluated in a larger series of patients.
Department of Dermatology and Pediatric Dermatology, Saint-André and Pellegrin Hospitals, Bordeaux University Hospitals, Bordeaux, France. catherine.droitcourt@gmail.com
Catherine
C
Droitcourt
Brigitte
B
Milpied
Khaled
K
Ezzedine
Thomas
T
Hubiche
Emilie
E
Belin
Fabrice
F
Akpadjan
Alain
A
Taïeb
Julien
J
Seneschal
D000293:Adolescent; D000328:Adult; D000506:Alopecia Areata / Q000188:drug therapy*; D003879:Dermatologic Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D020551:Pulse Therapy, Drug; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D003879:Dermatologic Agents; D005938:Glucocorticoids; D008775:Methylprednisolone; D008727:Methotrexate