Low-Dose Systemic Methotrexate Therapy for Recalcitrant Alopecia Areata

Background: Alopecia areata (AA) is an autoimmune skin disease difficult to manage and treat. The pathogenesis of AA features a T-cell-associated autoimmune process, and systemic immunosuppressive therapy is prescribed widely for AA. Objective: To evaluate the efficacy and tolerance of systemic low-dose methotrexate (LD-MTX) therapy in treatment of recalcitrant AA multiplex. Methods: In a retrospective, non-controlled study, we evaluated 29 patients with recalcitrant AA treated with LD-MTX and assessed the therapeutic response according to severity of disease, disease duration, cumulative dose of MTX, and drug safety. Results: MTX was administered twice weekly, and the mean maximum weekly dose was 14.48 mg. The response was A5 (regrowth =100.0%) in 14 (48.3%) patients and A4 (regrowth of 75%similar to 90%) in 12 (41.4%) patients. Three patients had poor response to LD-MTX treatment (A2: n = 2 [6.9%], A1: n = 1 [3.4%]). All three of the patients showing a poor response had disease durations exceeding 24 months. Relapse was observed in 31 of patients with more than 75% regrowth. Common side-effects were elevated liver enzyme levels and gastrointestinal discomfort. Conclusion: LD-MTX appears to be an effective and well-tolerated treatment for recalcitrant AA multiplex.