title: High Relapse Rates Despite Early Intervention with Intravenous Methylprednisolone Pulse Therapy for Severe Childhood Alopecia Areata.
abstract: BACKGROUND
  Previous data suggest that early application of intravenous methylprednisolone pulse therapy (IV-MPPT) may improve the disease course of alopecia areata. The objective of this study was to investigate the outcome of IV-MPPT in severe childhood alopecia areata, predominantly with short disease duration.
  
  
  METHODS
  Eighteen children (10 girls, 8 boys) younger than 17 years old (median age 7.7 yrs, range 2.1-16.5 yrs) treated with IV-MPPT for severe childhood alopecia areata in a referral center for pediatric dermatology over 3 years (median disease duration 4 mos, range 1-12 mos) were retrospectively evaluated. Five patients had alopecia areata totalis or universalis and 13 had alopecia multilocularis. The median scalp area affected by alopecia was 60% (range 30%-100%). All patients underwent two or three cycles of IV-MPPT at monthly intervals (maximum 500 mg/day on three consecutive days).
  
  
  RESULTS
  Within 7 months after the last IV-MPPT session, 10 of 18 children had good response (≥75% of hair regrowth), with eight showing improvement within the first 4 months. Of the remaining eight patients, one had moderate response (50%-74% regrowth), three had poor response (1%-49% regrowth), and four (all with alopecia areata universalis or totalis) had no response. Seven of the initial 10 good responders experienced relapses, with marked hair loss after the last IV-MPPT session. The estimated median time to relapse was 8 months (95% confidence interval 7, 9 mos).
  
  
  CONCLUSIONS
  IV-MPPT, even early in the course of disease, did not affect long-term outcome of alopecia areata in our group of severely affected patients.
authors: Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland.
authors: Alexandra
authors: A
authors: Smith
authors: Center for Dermatology and Hair Diseases Professor Trüeb, Wallisellen, Switzerland.
authors: Ralph M
authors: RM
authors: Trüeb
authors: Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland.|Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
authors: Martin
authors: M
authors: Theiler
authors: Pediatric Dermatology, Ostschweizer Children's Hospital, St. Gallen, Switzerland.
authors: Valérie
authors: V
authors: Hauser
authors: Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland.|Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
authors: Lisa
authors: L
authors: Weibel
mesh_terms: D000293:Adolescent; D000506:Alopecia Areata / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D020551:Pulse Therapy, Drug; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone