pulse prednisolone therapy in alopecia areata
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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 age.

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 upset.

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.

Pulse 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. PMID: 15692475
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