Comparison of therapeutic effect of high dose corticosteroid pulse therapy and combination therapy of cyclosporine with low does corticosteroid for severe alopecia Areata

초록

Background: Severe alopecia areata (AA) is difficult to treat. Treatment modalities such as topical and systemic immune modulators, corticosteroids and topical sensitizers have been tried. Among them, encouraging results have been reported with high dose pulse corticosteroid therapy. Objective: The aim of this study was to determine the effectiveness of a high dose corticosteroid pulse therapy in patients with severe AA compared with a group treated with oral cyclosporine with low dose corticosteroid. Methods: A total of 105 patients with severe AA were treated with high dose corticosteroid pulse therapy and 41 patients those were treated with oral cyclosporine (3~5 mg/kg/day) with low dose methylprednisolone (2.5 - 5 mg/day). Results: Therapeutic effect of high dose corticosteroid pulse therapy was better in shorter disease duration (<6 months, 81.4%; >6-12 months, 52.6%; >13 months, 37.3%) and less extensive type (AA multiplex, 80.0%; alopecia totalis, 41.2%; alopecia universalis, 27.8%). Therapeutic effect of oral cyclosporine with low dose corticosteroid therapy was better in less extensive type (AA multiplex, 75.0%; alopecia totalis, 41.2%; alopecia universalis, 25.0%). Disease duration did not significantly affect treatment response. High dose corticosteroid pulse therapy was more effective method (65.7%) than combination regimen of oral cyclosporine with low dose methylprednisolone (46.3%), especially in the case of shorter disease duration (p<0.05). Conclusion: High dose corticosteroid pulse therapy might be a more effective therapy for severe AA than other treatments, especially when in the acute stage (<6 months).

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