Long-term follow-up of the efficacy of methotrexate alone or in combination with low doses of oral corticosteroids in the treatment of alopecia areata totalis or universalis

Background. - Treatment of severe and chronic forms of alopecia areata (AA) totalis remains difficult. It has been suggested that methotrexate (MTX) is an efficacious treatment for AA total's. The aim of our study was to assess the long-term safety and efficacy of MIX in patients with chronic severe forms of AA totalis. Patients and methods. - Thirty-three patients (24 women and nine men) with AA total's or universal's were included. Mean disease duration was 7.7 years and these patients had not responded to prior standard treatment. The initial weekly dosage of MIX was 15 mg (n = 2), 20 mg (n = 16) or 25 mg (n = 15). Nineteen patients (58%) were treated with MTX and low doses of corticosteroids (prednisone 10-20 mg/d), while 14 patients (42%) received MIX alone. The primary end-point was complete hair regrowth under treatment. Results. - Twenty-one patients had total hair regrowth and 13 patients were considered as treatment failures, with 10 of these having partial regrowth and three having no regrowth. Complete regrowth was seen in 12 of 19 patients (63%) on combined treatment and in eight of 14 patients (57%) on MIX alone. The onset of hair regrowth was noted after a median delay of 3 months. At the end of the study, after a median of 30 months' follow-up, the median cumulative dose of MIX was 1.8 g (400 mg-5.5 g). Relapse was observed on corticosteroid dose reduction or withdrawal in 16 of the 20 patients in whom total hair regrowth initially occurred. Regrowth after treatment of relapse was seen in 14 of these 16 patients (87%). Seven patients experienced adverse events consisting of transient elevated transaminases (n = 4), persistent nausea (n = 2) and lymphocytopenia (n = 1). Conclusion. - MTX alone or in combination with low doses of oral corticosteroids resulted in complete hair regrowth in about half of these patients presenting AA total's or universalis. Lasting improvement required continuous treatment in most cases. (C) 2010 Elsevier Masson SAS. All rights reserved.