Prognostic Factors Influencing Therapeutic Effect in Methylprednisolone Pulse Therapy for Alopecia Areata

Im, Myung; Park, Young Ok; Seo, Young Joon; Lee, Jeung Hoon; Park, Jang Kyu

Abstract

BACKGROUND
Many treatments induce remission in patients with alopecia areata. Among them, systemic steroids may be effective in the treatment of severe alopecia areata, however, they have many side effects. To avoid side effects, high doses of a bolus infusion of methylprednisolone have been used to treat severe alopecia areata. OBJECTIVE: To confirm the effect of pulse therapy and to evaluate the prognostic factor associated with pulse therapy. METHOD: The medical records of 60 patients with alopecia areata between 2001 and 2004 at the Department of Dermatology, Chungnam National University Hospital were reviewed. All patients were treated with methylprednisolone pulse therapy. RESULTS: 1. 73.3% (44/60) of patients showed terminal hair growth, and 41.7% (25/60) of patients completely responded to this therapy with a cosmetically acceptable outcome. 2. Prognostic factors that influenced the result of the therapy were type of alopecia areata and disease duration before treatment. 3. Based on these 2 factors (type & duration), we suggest the following indications of methylprednisolone pulse therapy for severe alopecia areata. (1) Absolute indication (1) less than 3 months' duration with any type of alopecia (2) 4-6 months' duration with plurifocal alopecia (2) Relative indication (1) 4-6 months' duration with alopecia totalis and universalis (2) 7-12 months' duration with plurifocal alopecia (3) Borderline indication (1) 7-12 months' duration with alopecia totalis (2) 13-24 months' duration with plurifocal alopecia (4) Hopeless (1) 7-12 months' duration with alopecia universalis (2) 13-24 months' duration with alopecia totalis and universalis (3) more than 25 months' duration with any type of alopecia CONCLUSION: Methylprednisolone pulse therapy appears to be well tolerated and effective in patients with rapidly progressing extensive alopecia areata of any type which is treated within 6 months of disease onset, and the plurifocal type with 7-12 months of disease onset.