title: Combined oral pulse and topical corticosteroid therapy for severe alopecia areata in children: a long-term follow-up study.
abstract: There are no widely accepted therapy protocols for severe alopecia areata (AA). We treated 65 children/adolescents with AA affecting >30% of scalp. Fourty-three percent of patients had AA plurifocalis (AAP). Fifty-seven percent had AA subtotalis (AAS), AAP+ophiasis (AAP+OPH), and alopecia totalis/universalis (AT/AU). Long-term follow-up (median 96 months) data were available for 69% of patients. Oral dexamethasone (prednisolone 5 mg/kg equivalent) was given once in 4 weeks. Patients received 6, 9, or 12 pulses. Clobetasol propionate 0.05% ointment under plastic wrap occlusion was applied 6 days a week. Hair growth was assessed on a scale ranging 0-100% of regrowth in individual AA lesions. Regrowth >50% was considered good response. Six to twelve months months after the therapy, 56.9% of patients had >75% of hair regrowth. In AAP, 65.5% had complete regrowth. 61.5% of all patients were considered good responders. Significantly, higher percentage of good responders was found in AA lasting ≤12 months. No patients had serious side effects. There was no change in stability of the hair status at the long-term follow-up. Most AA patients had beneficial effects with this protocol. Best results were in AAP and AAP+OPH. Combined topical and oral pulse corticosteroid therapy of AA in children shows long-lasting results, without serious side effects.
authors.affiliation: Division of Pediatric Dermatology, Clinic of Dermatovenereology, Clinical Center of Serbia.
authors.forename: Jovan
authors.initials: J
authors.lastname: Lalosevic
authors.affiliation: Division of Pediatric Dermatology, Clinic of Dermatovenereology, Clinical Center of Serbia.|Faculty of Medicine, University of Belgrade.
authors.forename: Mirjana
authors.initials: M
authors.lastname: Gajic-Veljic
authors.affiliation: Faculty of Medicine, University of Belgrade.|Clinic of Allergy and Clinical Immunology, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Branka
authors.initials: B
authors.lastname: Bonaci-Nikolic
authors.affiliation: Division of Pediatric Dermatology, Clinic of Dermatovenereology, Clinical Center of Serbia.|Faculty of Medicine, University of Belgrade.
authors.forename: Milos
authors.initials: M
authors.lastname: Nikolic
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000293:Adolescent; D000506:Alopecia Areata / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D002990:Clobetasol / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D020551:Pulse Therapy, Drug; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D002990:Clobetasol
keywords: alopecia therapy; clobetasol; pulse corticosteroids