Pediatric Pulse Dose Corticosteroid Therapy Dosing and Administration in the Treatment of Alopecia Areata

Abstract

BACKGROUND

The use of pulse dose corticosteroid therapy (PDCT) in children for treatment of alopecia areata (AA) has been reported, but dosing regimens are not well-established. We aim to evaluate the available literature regarding the utilization and various dosing regimens of PDCT, as well as associated side effects, in the treatment of AA in children.

METHODS

We performed a systematic review of studies describing the use of PDCT for the treatment of AA in children.

RESULTS

Eight relevant studies were identified, five of which administered the treatment intravenously (IV) and three of which administered the treatment orally. Protocols with IV administration included two studies which used IV dexamethasone at 1.5 mg/kg/day for 1-3 days monthly for a maximum of 12 cycles and three studies used IV methylprednisolone 8-30 mg/kg/day for 1-3 days monthly for a maximum of 3-10 cycles. The three protocols with oral administration included variable doses of prednisolone at variable intervals and cycle lengths, betamethasone and dexamethasone at a prednisolone equivalent of 5 mg/kg, and methylprednisolone 15 mg/kg for 3 days bimonthly for 12 cycles. In these studies, PDCT was generally well-tolerated and resulted in improvement of the AA.

CONCLUSION

PDCT was found to be well-tolerated with few serious side effects reported. It appears to be beneficial early in disease course, especially for those with multifocal AA.

Pediatric Dermatology

Pediatric pulse dose corticosteroid therapy dosing and administration in the treatment of alopecia areata: A review of literature

Pediatr Dermatol 2022 Dec 02;[EPub Ahead of Print], NM Gallaga, B Carrillo, A Good, A Munoz-Gonzalez, L Ross

Written by



Sarah L. Chamlin MD

This systematic review of oral and intravenous pulse dose corticosteroid therapy in pediatric alopecia areata (AA) patients identified 8 articles for inclusion.  Most often dexamethasone or methylprednisolone were used in varying regimens.  Studies included 1 to 65 participants with the 5 largest studies showing hair regrowth in most participants, however, relapse rates ranged from 25-88%.    

Although effective therapy is limited for pediatric AA, I very rarely prescribe pulse or tapering courses of systemic corticosteroids for pediatric AA.  The benefit rarely outweighs the risks of systemic steroid side effects and the known high relapse rate.  The approval of baricitinib for adult patients with AA and the off-label use of this and other JAK inhibitors in pediatrics provides hope and promise for pediatric AA.

TAKE-HOME MESSAGE

• This systematic review involving pediatric patients with alopecia areata who underwent pulse dose corticosteroid therapy found various intravenous and oral steroid regimens. Of the 216 children included in the studies, 56% reported >50% regrowth of scalp hair. The relapse rates were high, and there were few adverse reactions. Increased doses, lower disease severity, multifocal disease, and recent disease onset were associated with better responses.
• Pulse dose corticosteroid therapy for pediatric patients with alopecia areata is well-tolerated and results in an improvement in the majority of patients; however, relapse rates appear to be high.

–  Kelly B. Scarberry, MD