The effect of methylprednisolone pulse-therapy plus oral cyclosporine in the treatment of alopecia totalis and universalis

The exact etiology of alopecia areata is still unknown, and no completely effective treatment has been established. The use of oral steroids for treating this disorder is controversial and may have potential side effects. Relapses are also common upon withdrawal of the medication. The objective of this study was to evaluate the therapeutic and side effects of pulse-therapy with methylprednisolone combined with oral cyclosporine in severe alopecia areata, defined as alopecia totalis and universalis. Six patients with alopecia totalis and 12 patients with alopecia universalis were referred to our center. The patients were treated with monthly intravenous methylprednisolone in doses of 500 mg for three days and oral cyclosporine (2.5 mg/kg/day) for five to eight months. Responses were categorized as: "adequate" (i.e., hair regrowth on >= 70% of the affected area) and "inadequate" (i.e., hair regrowth on <70% of the affected area). Adequate response was observed in six (33%) patients: three with alopecia totalis and 3 with alopecia universalis. Responses were better in patients with alopecia totalis, age >20 years, negative history of atopy, negative family history of alopecia areata, presence of nail pitting, and pruritus in the affected area. No cases of relapses and no severe side effects were observed. Patients with severe and resistant alopecia areata, if properly selected, may benefit from intravenous methylprednisolone pulse-therapy plus oral cyclosporine.