title: Sequential high- and low-dose systemic corticosteroid therapy for severe childhood alopecia areata.
abstract: BACKGROUND
  Given the limited number of therapeutic options, severe childhood alopecia areata (AA) poses a clinical challenge. The best and most rapid response rates can be achieved with high-dose systemic corticosteroids, however, relapse following treatment discontinuation is inevitable. Due to systemic side effects, long-term high-dose corticosteroid regimens are not feasible. Following initial pulse therapy, continuation of corticosteroid therapy at a dose below the Cushing threshold might be able to suppress disease activity without causing severe side effects.
  
  
  METHODS
  Thirteen children with severe AA were enrolled in our open observational study. Seven had alopecia totalis or universalis; the remaining six children had multifocal alopecia affecting more than 50 % of the scalp. The treatment regimen consisted of initial pulse therapy with prednisolone 2 mg/kg PO, which was subsequently tapered to a maintenance dose below the individual Cushing threshold within nine weeks. Children were followed-up for one to three years.
  
  
  RESULTS
  Sixty-two percent of individuals showed complete hair regrowth. The mean time to response was 6.6 weeks. Said response was sustained with maintenance therapy for the entire follow-up period. Noticeable side effects included weight gain (1-3 kg), which was observed in all children, and mild steroid acne in 23 % of cases.
  
  
  CONCLUSIONS
  Sequential high- and low-dose prednisolone therapy is an effective and safe therapeutic option for childhood AA.
authors.affiliation: Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University of Vienna, Vienna, Austria.
authors.forename: Karin
authors.initials: K
authors.lastname: Jahn-Bassler
authors.affiliation: Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University of Vienna, Vienna, Austria.
authors.forename: Wolfgang Michael
authors.initials: WM
authors.lastname: Bauer
authors.affiliation: Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University of Vienna, Vienna, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Karlhofer
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
authors.forename: Matthias G
authors.initials: MG
authors.lastname: Vossen
authors.affiliation: Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University of Vienna, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Stingl
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D000506:Alopecia Areata / Q000188:drug therapy*; D001317:Austria; D002648:Child; D002675:Child, Preschool; D003480:Cushing Syndrome / Q000139:chemically induced / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006197:Hair / Q000187:drug effects; D006801:Humans; D008134:Long-Term Care; D008297:Male; D020551:Pulse Therapy, Drug; D012008:Recurrence; D017211:Treatment Failure
chemical_list: D000305:Adrenal Cortex Hormones