Pulse steroid therapy for alopecia areata: how good is it?

Pulse therapy helps those with recent onset hair loss

Alopecia areata is an autoimmune disease that affects children and adults. There are several possible treatments including topical steroids, steroid injections, minoxidil,  anthralin, diphencyprone, oral steroid, methotrexate, sulfasalazine, cyclosporine.

Oral steroids are often used as "pulse therapy" meaning the steroids are given for short periods of time with long breaks in between. A recent study looked at all of the published studies to date looking at the benefits of such a treatment plan in patients with alopecia areata. A total of 41 studies with 1078 were included in the researchers analyses.

Not surprisingly, the review showed that pulse therapy is effective for many patients - but not all. 

Best prognosis in those with 3 factors

These studies showed that patients with three factors seemed to respond best to pulsed steroid therapy, including those with what I call the "3 S's of steroid therapy"

1. START OF DISEASE.

• Individuals who just developed their first episode of alopecia areata respond best to steroid treatments than than those who have had previous patches in the past. 

2. SOME HAIR REMAINING. 

• Individuals who have multiple patches of alopecia rather than complete loss of hair respond best to steroid than than those who have had the condition for a long time. 

3. SHORT DURATION

• Individuals who have developed hair loss within the past 2 years respond best to steroid than than those who have been without hair for a long time. 

REFERENCE
Shreberk-Hassidim R et al. A systematic review of pulse steroid therapy for alopecia areata. J Am Acad Dermatol Feb 2016.