The Efficacy and Adverse Effects of Corticosteroid Pulse Therapy in Alopecia Areata

Fatemeh  Rastaghi; Roxana  Kaveh; Nazafarin  Yazdanpanah; Akram-Sadat  Sahaf; Najmeh Ahramiyanpour

doi:10.5826/dpc.1304a255

The Efficacy and Adverse Effects of Corticosteroid Pulse Therapy in Alopecia Areata

Authors

Fatemeh Rastaghi Department of Dermatology, Afzalipoor Hospital, Kerman University of Medical Sciences, Kerman, Iran
Roxana Kaveh Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
Nazafarin Yazdanpanah Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Akram-Sadat Sahaf Department of Dermatology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Najmeh Ahramiyanpour Department of Dermatology, Afzalipoor Hospital, Kerman University of Medical Sciences, Kerman, Iran

Keywords:

alopecia areata, corticosteroid, pulse therapy

Abstract

Introduction: Alopecia areata (AA) is a non-scarring, autoimmune hair loss disorder, varying in severity from small round hairless patches to the total loss of scalp or body hair. Steroid pulse therapy outcomes for AA vary.

Objective: This study aimed to review the related literature regarding the efficacy, relapse rates, side effects, and prognostic factors associated with the response to different pulse corticosteroid treatments.

Methods: The terms "pulse steroid therapy AND alopecia areata" and "pulse corticosteroid therapy AND alopecia areata" were searched on PubMed and Google Scholar.

Results: A total of 24 articles were assessed. There was no difference in outcomes and side effects between intravenous and oral pulse corticosteroid therapy. The relapse rate and efficacy depended on the time of AA onset, age, and type: improved outcomes and decreased relapse were linked with recent onset (<6 months), younger age (<10 years), and the multifocal type. Patients with a past medical history of atopy, nail pitting, or thyroid disease and those with severe forms of AA, like alopecia totalis and alopecia universalis, had the least improvement.

Conclusion: Pulse corticosteroids effectively induce hair regrowth in AA. Betamethasone seems to be the most effective agent (followed by intramuscular triamcinolone), especially in severe cases, but more side effects may accompany it. Combining this agent with other medications can reduce the dosage and side effects. Pulses of prednisolone and methylprednisolone are less effective but safer, as they have low relapse rates and adverse effects. A combination of them with other drugs can increase their efficacy.

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