Corticosteroids only help minority of alopecia patients

By Helen Albert, Senior medwireNews reporter

Results from a long-term study show that pulsed corticosteroid treatment is only effective in about a third of alopecia patients.

"The management of extensive alopecia areata (AA) is a difficult challenge due to a lack of evidence-based data on the available therapies," say Delphine Staumont-Sallé (University of Lille, France) and colleagues.

High-dose pulsed corticosteroids can induce hair regrowth in the short term in people with alopecia, but little is known about the long-term effects of this therapy.

To investigate further, Staumont-Sallé and colleagues followed up 30 patients treated with high-dose intravenous methylprednisolone 500 mg to 1 g/kg (10-20 mg/kg for children) for 3 days a month for a maximum of 3 months between 1995 and 2000.

Of the 30 patients who completed both short- and long-term follow up, 16 had a form of AA, seven had alopecia totalis (AT), and six had alopecia universalis (AU). Six months after their initial treatment, 10 patients had significant hair regrowth: seven AA patients, two AT patients, and one AU patient.

As reported in Dermatology, long-term outcomes were assessed after a mean follow-up period of 12.3 years. At this time, eight of the 10 patients who initially responded to treatment continued to have mild or no disease and 14 of the 20 who initially had no response continued to have severe alopecia symptoms. Notably, additional treatment after 6 months did not seem to greatly influence outcomes at 12.3 years.

As might be expected, patients who responded to treatment had a significantly better score on the Dermatology Life Quality Index than those who did not, at a mean of 3.1 versus 7.5 out of 30.

"Although our study is not prospective and suffers from recall bias, it has the advantage of providing data on the long-term outcomes of patients treated with corticosteroid pulse therapy, taking into account the patients' self-assessments of hair regrowth and quality of life," write Staumont-Sallé et al.

"A prospective study is ongoing to confirm our results," they conclude.

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