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High Relapse Rates Despite Early Intervention with Intravenous Methylprednisolone Pulse Therapy for Severe Childhood Alopecia Areata


Smith, Alexandra; Trüeb, Ralph M; Theiler, Martin; Hauser, Valérie; Weibel, Lisa (2014). High Relapse Rates Despite Early Intervention with Intravenous Methylprednisolone Pulse Therapy for Severe Childhood Alopecia Areata. Pediatric Dermatology, 32(4):481-487.

Abstract

BACKGROUND Previous data suggest that early application of intravenous methylprednisolone pulse therapy (IV-MPPT) may improve the disease course of alopecia areata. The objective of this study was to investigate the outcome of IV-MPPT in severe childhood alopecia areata, predominantly with short disease duration. METHODS Eighteen children (10 girls, 8 boys) younger than 17 years old (median age 7.7 yrs, range 2.1-16.5 yrs) treated with IV-MPPT for severe childhood alopecia areata in a referral center for pediatric dermatology over 3 years (median disease duration 4 mos, range 1-12 mos) were retrospectively evaluated. Five patients had alopecia areata totalis or universalis and 13 had alopecia multilocularis. The median scalp area affected by alopecia was 60% (range 30%-100%). All patients underwent two or three cycles of IV-MPPT at monthly intervals (maximum 500 mg/day on three consecutive days). RESULTS Within 7 months after the last IV-MPPT session, 10 of 18 children had good response (≥75% of hair regrowth), with eight showing improvement within the first 4 months. Of the remaining eight patients, one had moderate response (50%-74% regrowth), three had poor response (1%-49% regrowth), and four (all with alopecia areata universalis or totalis) had no response. Seven of the initial 10 good responders experienced relapses, with marked hair loss after the last IV-MPPT session. The estimated median time to relapse was 8 months (95% confidence interval 7, 9 mos). CONCLUSION IV-MPPT, even early in the course of disease, did not affect long-term outcome of alopecia areata in our group of severely affected patients.

Abstract

BACKGROUND Previous data suggest that early application of intravenous methylprednisolone pulse therapy (IV-MPPT) may improve the disease course of alopecia areata. The objective of this study was to investigate the outcome of IV-MPPT in severe childhood alopecia areata, predominantly with short disease duration. METHODS Eighteen children (10 girls, 8 boys) younger than 17 years old (median age 7.7 yrs, range 2.1-16.5 yrs) treated with IV-MPPT for severe childhood alopecia areata in a referral center for pediatric dermatology over 3 years (median disease duration 4 mos, range 1-12 mos) were retrospectively evaluated. Five patients had alopecia areata totalis or universalis and 13 had alopecia multilocularis. The median scalp area affected by alopecia was 60% (range 30%-100%). All patients underwent two or three cycles of IV-MPPT at monthly intervals (maximum 500 mg/day on three consecutive days). RESULTS Within 7 months after the last IV-MPPT session, 10 of 18 children had good response (≥75% of hair regrowth), with eight showing improvement within the first 4 months. Of the remaining eight patients, one had moderate response (50%-74% regrowth), three had poor response (1%-49% regrowth), and four (all with alopecia areata universalis or totalis) had no response. Seven of the initial 10 good responders experienced relapses, with marked hair loss after the last IV-MPPT session. The estimated median time to relapse was 8 months (95% confidence interval 7, 9 mos). CONCLUSION IV-MPPT, even early in the course of disease, did not affect long-term outcome of alopecia areata in our group of severely affected patients.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Children's Hospital Zurich > Clinic for Surgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2014
Deposited On:05 Feb 2016 12:01
Last Modified:05 Apr 2016 19:59
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:0736-8046
Publisher DOI:https://doi.org/10.1111/pde.12578
Related URLs:http://www.zora.uzh.ch/112088/
PubMed ID:25872976

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