Clinical Findings of 68 Cases of Severe Alopecia Areata and the Results of Methyl Prednisolone Pulse Therapy

Park, Soo Lieon; Ihm, Chull Wan

Abstract

BACKGROUND
Extensive involvernent of alopecia areata seems to be different from the usual common type of alopecia areata in its damage to the patient and its pragnosis. The two forms are best dealt with differently. OBJECTIVE: We performed a clinical observation of a severe form of alopecia areata to understand to its course and therapeuic respones.
METHODS
Clinical analysis of 68 cases of severe alopecia areata (37 alopecia totalis, 6 alopecia subtotalis, 13 alopecia universalis, 11 alopecia subtotal universalis, 1 ophiasis) was done for 9 years from 1985 to 1994.
RESULTS
1. The sex distribution was equal. The developrnent of hair loss started before the age of 30 in 67.6%(46/68). Twenty two patients(32.4%) developed the alopecia during the early twenties. The overall mean age was 26.4 years. 2. The duration from the initial hair loss to the involvement of the whole scalp was less than 3 months in 80%(40/50~) of patierits showing whole scalp baldness. 3. Exclamation mark hairs were seen in 85% (57/67) of severe alopecia areata. In 5 patients who were examined just at the start of the hair loss, exclamation mark hairs were found several weeks later. 4. When treated by methyl prednisolone pulse therapy, duration of the disease and type of involvement are the most important prognastic factors as follows. a) 71%(32/45) of patients with less than 6 months duration showed satisfyingly good results cosmetically, but this figure dropped to 30.4% (7/23) in patients with longer than 6 months duration. b) 83.7% (36/43) of patients with alopecia totalis or subtotalis showed good results but this figure dropped to 12%(3/25) in patients with alopecia universalis, subtotal universalis or ophiasis. 5. Methyl prednisolone pulse therapy seemed to be recommended in the acute stage of extensive involvement of alopecia areata.
CONCLUSION
Severe alopecia areata has predilection for young adults and seems to show extensive involvement frorn its early stage. Exclamation mark hairs need some time to appear even in their early active stage of hair hedding. Pulse methyl prednisolone therapy is thought to be recommended when the disease is in its early active stage.