Pulse prednisolone therapy in alopecia areata
Considered to be an autoimmune disease, alopecia areata is often
treated with systemic corticosteroids. Recently, oral pulse therapy
using prednisolone, a glucocorticoid used to treat many different
inflammatory conditions, was studied in a group of patients with
severe alopecia areata.
The study included 43 patients who had severe alopecia areata,
with more than 40% of hair loss on the scalp and more than 10%
on the body as patches characteristic of the disease. Patients
with alopecia universalis (fully 100% scalp and body hair loss),
diabetes, high blood pressure, cardiac and kidney related problems,
pregnant women, thyroid disorders, ulcers and those already undergoing
treatment for alopecia areata were excluded for this study. The
selected members were grouped into A and B groups comprising of
23 and 20 patients respectively. All the patients had to undergo
a series of medical tests such as blood pressure monitoring, weight,
blood sugar levels, urine tests, kidney and liver functioning
and chest radiography so that the effects of the steroid use for
treatment could be assessed. The patients were also monitored
for onset and site(s) of the disease, duration, amount of hair
loss, relapse if any, associated autoimmune disorders and nail
patterning along with general medical history of the patient and
The total study period was for 6 months. In the first 3 months,
patients in group A were given 200 mg prednisolone as five 40
mg tablets once a week, while the group B patients were given
equivalent placebo tablets. I the next 3 months no further treatment
was given and the effects of the treatment were studied. The resultant
hair growth was classified as good or marked when hair regrowth
was above 60%, 30-60% as moderate and below 30% as poor, with
moderate to good categories considered significant in the study.
A deterioration of more than 20% hair loss was considered a relapse
of the alopecia areata. Data obtained from all the 43 patients
was analyzed statistically using Fischer’s exact and chi
square tests. These are classic statistical calculations to compare
test groups and control groups to see if changes in one group
are truly significant.
From the 6 months of study it was observed that 40% of group
A patients showed significant hair growth. That is, out of the
23 patients in this group 8 patients experienced hair regrowth;
2 showed good regrowth and 6 had moderate regrowth. Of the 6 patients,
2 later had a relapse of the condition within the second three
month observation period. Of these two patients who experienced
a relapse, one patient had had the condition for more than 3 years
and also had some changes in his nail characteristics while the
other also had nail pitting and a family history of vitiligo,
an acquired skin disease characterized by patches of unpigmented
skin. So it may be that these two individuals had a stronger case
of autoimmunity compared to the others.
It was observed that those patients who received treatment who
were within less than 2 years of onset of alopecia areata and
were experiencing the condition for the first time, responded
to this medication well. In patients where their onset was more
than 2 years old and extensive, the treatment of pulse prednisolone
seems to be of not so much help. A combination therapy of topical
steroids and sensitizers, Ultra violet A light, minoxidil and
immunomodulators may be of help for these individuals according
to the study authors.
The use of prednisolone indicated a high percentage of side effects
during the first 3 months of the treatment which faded away during
the second 3 month study period. The side effects in group A patients
amounted to 55% affected and included general weakness during
the first 2 days, acne like eruptions, abnormally light or infrequent
menstruation, gain in weight, mooning of the face and gastrointestinal
Use of the pulse corticosteroid method in treating alopecia areata
was first introduced in 1975 by doctors Burton and Shuster. Studies
using 300 mg oral prednisolone and 5 mg dexamethasone administered
twice weekly were carried out in the late 1990s for improvement
of alopecia areata with a reduced percentage of side effects.
Here a 200mg prednisolone pulse treatment was used.
Although the percentage of side effects in this study was higher,
it is notable that the side effects faded during the follow up
period. Since prednisolone pulse treatment has put forth good
results, further optimization of the dosage with increased benefits
and reduced side effects should be investigated claimed the authors.
prednisolone therapy in alopecia areata references
- Kar BR, Handa S, Dogra S, Kumar
B. Placebo-controlled oral pulse prednisolone
therapy in alopecia areata.
J Am Acad Dermatol. 2005 Feb;52(2):287-90.