Therapy
Placebo-controlled oral pulse prednisolone therapy in alopecia areata

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Background

Systemic corticosteroids administered as pulse therapy have been found helpful in a wide array of diseases including alopecia areata (AA). None of the studies published so far regarding their use in AA have been randomized or placebo-controlled.

Objective

We sought to compare the efficacy of weekly oral prednisolone pulse therapy in a placebo-controlled trial for patients with extensive AA.

Methods

A total of 43 patients were randomly divided into two groups. Patients in group A (23 patients) were treated with oral prednisolone (200 mg once weekly, 5 40-mg tablets) and patients in group B (20 patients) were given placebo tablets on an identical schedule. The total study period was 6 months, consisting of 3 months of active therapy followed by another 3 months of observation.

Results

Significant hair regrowth was obtained in 8 patients in the prednisolone-treated group. Two of the responders experienced a relapse during the observation period of 3 months. In the placebo group, none of the patients had significant hair regrowth at the end of the study.

Conclusion

Oral prednisolone pulse therapy is useful in AA. Placebo-controlled studies with varying dosage schedules are required to standardize the dose of prednisolone used in pulse therapy, optimize the therapeutic efficacy, and minimize side effects.

Section snippets

Patients and methods

A total of 43 consecutive patients with severe AA (≥40% loss of scalp hair or >10 patches scattered over the scalp and body) were included in the study. Patients were divided into two groups based on randomization using Tippet's random number table. Group A (n = 23) was started on weekly oral prednisolone pulse therapy (200 mg) whereas group B (n = 20) was given identical placebo tablets once weekly for 3 months. Patients were followed-up monthly for 3 months after completion of the oral pulse

Results

Of 43 patients, 7 patients (3 from group A and 4 from group B) were lost to follow-up because of reasons unrelated to the study. Comparative details of both groups are given in Table I. Significant regrowth of hair was seen in 8 (40%) patients for group A at the end of 3 months. Of these 8 patients, two had marked to complete growth of hair (Fig 1, Fig 2, Fig 3) and 6 had moderate growth. Two (25%) patients from among the 8 responders had relapse at the end of 3 months of follow-up. One of

Discussion

AA is an autoimmune disorder with an unpredictable, relapsing course. It is hypothesized to be an organ-specific autoimmune disease mediated by T lymphocytes directed at hair follicles. Although genetic predisposition and environmental factors may trigger the initiation of the disease, its exact cause is still unknown.1, 2, 3, 4, 5, 6 The cosmetic disfigurement resulting from the disease leads to marked psychologic morbidity.13 Extensive AA is difficult to treat and modalities such as topical

References (19)

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Funding sources: None.

Conflicts of interest: None identified.

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