Efficacy and safety of oral mega pulse methylprednisolone for severe therapy resistant Alopecia areata.

OBJECTIVES: To use intensive regimen of pulse steroid in the severe forms of Alopecia areata.

METHODS: This prospective randomized study was conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between 2003 to 2009. Patients with Alopecia universalis, Alopecia totalis, or Alopecia ophiasis were assigned to one of the 3 treatment groups: Group A received oral mega pulse methylprednisolone (MP) for 3 consecutive days once every 2 weeks for 24 weeks; Group B received 2 consecutive daily pulses every 3 weeks; and Group C received 3 consecutive daily pulses every 3 weeks. Patients who showed regrowth of 75% or more at 24 or 36 weeks continued their treatment, while intervals were increased gradually.

RESULTS: Forty-two patients were included in this study, and 52.4% of them had atopic diathesis, while 35.7% had autoimmune thyroiditis. At 36 weeks, 12 (28.6%) patients had adequate response, 9 (21.4%) had inadequate response, and 21 (50%) patients had poor response. The response rate shows no statistically significant difference between treatment groups. There were statistically significant differences in age of onset, duration of the disease, and presence of subclinical hypothyroidism between different response groups. At follow-up: 13 (38.2%) patients relapsed; 5 (14.7%) patients developed moderate hair fall; 3 (8.8%) patients developed mild hair fall; 7 (20.1%) patients maintained their hair regrowth; and 6 (17.6%) patients were lost follow up. It was relatively well-tolerated among groups B and C.

CONCLUSIONS: Oral mega pulse MP use in severe forms of Alopecia areata has relative efficacy and tolerance but with high relapse rate.