Efficacy and Safety of Methotrexate and Prednisolone in the treatment of Severe Alopecia areata

Abstract

Background: Alopecia areata is a chronic disorder of hair follicles of unknown ae?ology with clear autoimmune components. Several therapeutic options have been suggested; however, no treatment can modify the disease course. Recently Methotrexate introduce as a safe and effective corticosteroid-sparing agent in several autoimmune diseases as well as in alopecia areata.

Objectives: To evaluate the efficacy and safety of methotrexate and prednisolone in severe alopecia areata. Methods: In a prospective consecutive case series study, 15 patients were evaluated who had severe alopecia areata (AA) with a mean dura?on 7.60 years and were treated with 15 mg/weekly methotrexate (MTX) with 20 mg /day oral Prednisolone. All patients were recruited from the outpatient department of Dermatology and Venereology at Shaheed Suhrawardy Medical College and Hospital, Dhaka and two private dermatology clinics from January 2015 to December 2019.

Results: A total regrowth of terminal hair was regarded as a success. Success was achieved in 73.33% of patients. Within a mean follow-up of 14.86 months a?er treatment, relapse occurs in 6 patients (focal/multifocal in 4 patients, diffuse loss in 2 patients). Relapse resolved by potent local corticosteroid application for focal/multifocal cases and restarting the previous dosage of medication for diffuse cases. Complications were minor and resolved spontaneously.

Conclusion: Methotrexate plus oral corticosteroid appears to be a promising, inexpensive and safe medica?on for the treatment of severe alopecia areata.

Keywords: Methotrexate, Prednisolone, alopecia areata, efficacy.