title: Efficacy and Safety of Methotrexate Combined with Low- to Moderate-Dose Corticosteroids for Severe Alopecia Areata.
abstract: BACKGROUND
  In severe alopecia areata (AA), spontaneous recovery is unlikely, and treatment is not standardized.
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of methotrexate (MTX) used alone or combined with low- to moderate-dose oral corticosteroids (OC) for treating severe AA (totalis, universalis and severe multifocal).
  
  
  METHODS
  Retrospective monocentric study of all consecutive patients receiving this treatment between 2006 and 2012. Efficacy was defined as achieving a total regrowth of terminal hair.
  
  
  RESULTS
  26 patients were included (17 with AA universalis or totalis and 9 with severe multifocal AA). Total regrowth was noted in 15/26 patients. After 3 months of treatment, hair regrowth >80% was associated with further complete regrowth, and hair regrowth <30% was associated with later treatment failure (p = 0.0014). When treatment was tapered, 11/15 patients with initial complete efficacy experienced AA relapse.
  
  
  CONCLUSIONS
  MTX combined with low- to moderate-dose OC may be an efficient and well-tolerated treatment for severe AA. However, long-term maintenance treatment is usually required.
authors.affiliation: Department of Dermatology, Reims University Hospital, Reims, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Anuset
authors.forename: Geraldine
authors.initials: G
authors.lastname: Perceau
authors.forename: Philippe
authors.initials: P
authors.lastname: Bernard
authors.forename: Ziad
authors.initials: Z
authors.lastname: Reguiai
mesh_terms: D000293:Adolescent; D000328:Adult; D000505:Alopecia / Q000188:drug therapy*; D000506:Alopecia Areata / Q000188:drug therapy*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage* / Q000009:adverse effects; D019233:Retreatment; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D003879:Dermatologic Agents; D011241:Prednisone; D008727:Methotrexate