title: Early intervention with high-dose steroid pulse therapy prolongs disease-free interval of severe alopecia areata: a retrospective study.
abstract: BACKGROUND
  Spontaneous recovery of severe alopecia areata is rare and the condition is difficult to treat.
  
  
  OBJECTIVE
  The aim of this study is to investigate and compare the effects and safety of steroid pulse therapy between oral and intravenous administrations between 1999 and 2010 at the Department of Dermatology, National Cheng Kung University Hospital.
  
  
  METHODS
  Data were retrospectively retrieved. A satisfactory response was defined as more than 75% hair regrowth in the balding area.
  
  
  RESULTS
  A total of 85 patients with more than 50% hair loss were identified and treated, with an overall satisfactory response rate of 51.8%. The mean follow-up time was 37.6 months, with a relapse rate of 22.7%. Patients with alopecia areata (hereafter, AA) of recent onset within one year showed higher response rates (p<0.001) and lower relapse rates compared to patients with AA persisting for more than 1 year. Further, even in patients with alopecia totalis, alopecia universalis or ophiasis type, early treatment resulted in a satisfactory response rate of 47% among the treated patients. In general, oral therapy was as effective and well-tolerated as intravenous therapy.
  
  
  CONCLUSIONS
  The response rate is determined by disease severity and time of intervention, not by the administration form of steroid pulse therapy. Oral steroid pulse therapy can be considered as the first-line treatment for patients with severe AA of recent onset within one year.
authors.affiliation: Department of Dermatology, National Cheng Kung University, College of Medicine, Tainan, Taiwan. ; Institute of Clinical Medicine, National Cheng Kung University, College of Medicine, Tainan, Taiwan.
authors.forename: Chao-Chun
authors.initials: CC
authors.lastname: Yang
authors.affiliation: Department of Dermatology, National Cheng Kung University, College of Medicine, Tainan, Taiwan.
authors.forename: Chun-Te
authors.initials: CT
authors.lastname: Lee
authors.affiliation: Department of Dermatology, National Cheng Kung University, College of Medicine, Tainan, Taiwan. ; Institute of Clinical Medicine, National Cheng Kung University, College of Medicine, Tainan, Taiwan.
authors.forename: Chao-Kai
authors.initials: CK
authors.lastname: Hsu
authors.affiliation: Department of Dermatology, National Cheng Kung University, College of Medicine, Tainan, Taiwan.
authors.forename: Yi-Pei
authors.initials: YP
authors.lastname: Lee
authors.affiliation: Department of Dermatology, National Cheng Kung University, College of Medicine, Tainan, Taiwan.
authors.forename: Tak-Wah
authors.initials: TW
authors.lastname: Wong
authors.affiliation: Department of Dermatology, National Cheng Kung University, College of Medicine, Tainan, Taiwan.
authors.forename: Sheau-Chiou
authors.initials: SC
authors.lastname: Chao
authors.affiliation: Department of Dermatology, National Cheng Kung University, College of Medicine, Tainan, Taiwan.
authors.forename: Julia Yu-Yun
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Dermatology, National Cheng Kung University, College of Medicine, Tainan, Taiwan.
authors.forename: Hamm-Ming
authors.initials: HM
authors.lastname: Sheu
authors.affiliation: Department of Dermatology and Allergy, Technische Universität München, Munich, Germany.
authors.forename: Wenchieh
authors.initials: W
authors.lastname: Chen
keywords: Alopecia areata; Corticosteroids; Pulse drug therapy; Treatment