IV Pulse Dexamethasone Plus [KL1] Topical Corticosteroids for Severe Pediatric Alopecia Areata

Researchers compared 1-day intravenous dexamethasone pulses with 3-day pulses in a small cohort of children and adolescents with severe AA.

According to study data published in Dermatologic Therapy, pulsed intravenous (IV) dexamethasone (DP) combined with topical corticosteroids was an effective and well-tolerated treatment for severe pediatric alopecia areata (AA).

Investigators in Belgrade, Serbia conducted a single-center prospective study of 73 children (aged 1 to 18 years) with severe AA. At baseline, they assessed sociodemographic and clinical characteristics. Researchers used the Severity of Alopecia Tool (SALT) to measure scalp hair loss. Patients received IV DP at 1.5 mg/kg/d for 1 day (1-DP) or 3 consecutive days (3-DP). Pulses were repeated every 4 weeks until each patient had received 6 pulses. In patients with incomplete response at 6 months, therapy was continued through 9 or 12 months. All patients applied topical clobetasol propionate 0.05% ointment under plastic wrap occlusion for 6 nights/week. Researchers evaluated hair regrowth every 3 months during pulse therapy and for several months thereafter. Patients achieving >50% regrowth per SALT were considered good responders.

Of 73 patients (50.7% boys), 37 received 1-DP and 36 received 3-DP. Mean patient age was 10.3±5 years in the 1-DP group and 9.8±3.6 years in the 3-DP group. Mean follow-up duration was 33.3±15.3 and 27.7±14.3 months in the 1-DP and 3-DP groups, respectively. Patients receiving 3-DP were more frequently classified as good responders compared with patients receiving 1-DP (66.7% vs 35.1%, respectively; P =.01).

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A greater number of patients in the 3-DP group also achieved >75% regrowth compared with patients in the 1-DP group (63.9% vs 24.3%, respectively; P =.001). Researchers observed relapses — defined as a SALT increase >10% during follow-up — more frequently in the 1-DP group compared with the 3-DP group (56.8% vs 30.6%, respectively; P =.034). In the 3-DP group, patients without Hashimoto thyroiditis (HT) had 9.8-fold higher odds of achieving >50% regrowth compared with patients with HT (odds ratio 9.8; 95% CI, 1.84-51.93; P =.007). Patients with AA plurifocalis (AA patches on 30% to 60% of scalp) achieved better results than patients with AA subtotalis (AA patches on 61% to 95% of scalp), and just 14.2% of patients with AA plurifocalis experienced relapse. During long-term follow-up, 67% of the 3-DP group had stable results.

The most commonly reported adverse effects were muscle pain and folliculitis, both of which were transient and required no further management. Investigators did not observe any long-term adverse effects in either treatment group.

In this prospective study of IV DP combined with topical corticosteroids, short disease duration and absence of HT were associated with better outcomes. Researchers concluded 3-DP was more efficacious than 1-DP and did not observe any severe safety signals.

“Our results demonstrate that combined pulsed IV and topical corticosteroid therapy

may be a useful and safe therapeutic approach in severe pediatric AA,” investigators wrote.

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Lalosevic J, Gajic-Veljic M, Bonaci-Nikolic B, Stojkovic Lalosevic M, Nikolic M. Combined intravenous pulse and topical corticosteroid therapy for severe alopecia areata in children: comparison of two regimens [published online October 3, 2019]. Dermatol Ther. doi:10.1111/dth.13092