Methotrexate for Treating Alopecia Areata in Children

New Study Indicates 1 in 3 Children with Alopecia Areata have Significant Regrowth on Methotrexate

Albela et al, 2022

A new study set out to evaluate the potential benefits of methotrexate for treating alopecia areata. This was a retrospective study of paediatric patients (aged 18 years and below) with AA who were treated with oral MTX seen between January 2019 until December 2020. There were 13 patients in the study including 6 boys and 7 girls. Twelve patients had moderate to severe alopecia AA (more than 50% loss) and one had 25-49 % loss.  The mean age of these patients at the commencement of MTX therapy is 8.8 years (range between 4 and 16 years old). The time interval between from the diagnosis of alopecia areata in these patients to commencement of MTX therapy was between 8 months and 9 years (mean duration of 3.3 years).

All patients had failed conventional first-line treatments prior to starting MTX such as topical steroid, oral steroid, minoxidil 2%, and topical squaric acid dibutylester (SADBE) immunotherapy. Three patients were started a course on oral prednisolone for 4–5 weeks simultaneously when starting MTX. Topical immunotherapy SADBE every 1–4 was continued concurrently with MTX for 9 patients. Oral MTX was prescribed in a conventional manner  once weekly, with a mean of maximal dose of MTX of 0.4 mg/kg/dose (range 0.3–0.5 mg/kg/dose).

Results

Of the 13 patients, data was available only for 12 patients as one patient was lost to follow up.

Among the 12 assessable patients, 5 had successful treatment response (42%). 1 had complete regrowth, 3 had significant near complete growth (approximately 33 % with cosmetically significant regrowth) and 1 had partial growth.  The mean duration from commencement of MTX therapy to hair regrowth was 4.2 months (range 2–7 months). The remaining 7 patients were considered as treatment failures as they had no response at all (5 patients) or only very partial responses (2 patients). There were no serious side effects of MTX reported and blood tests remained normal for all patients.

Comments and Discussion

I liked this study as it reminds us all that MTX is very much on the list of treatments for alopecia areata in children.

 A recent systemic review by Barton and colleagues of all treatments for alopecia areata showed that 65. 8 % of pediatric aged patients respond to MTX.  This is based on 8 articles reported studies of methotrexate, either as a solitary agent or in conjunction with other treatments in 42 pediatric patients. Complete response was seen on average in 17.9% (range 0% to 50%) and partial response in 47.9% (range 0% to 100%) with doses ranging from 2.5 mg to 25 mg per week.

 Children and adults can both benefit from MTX for alopecia areata. A meta-analysis by Phan et al suggested revealed a higher “complete response” in adult versus pediatric AA patients (44.7% vs 11.6%), although the relapse rate in children was significantly lower than that in adults (31.7% vs 52%).

REFERENCE

Albela H et al. Efficacy and Tolerability of Methotrexate in the Treatment of Severe Paediatric Alopecia Areata. Skin Appendage Disord. 2022 May;8(3):206-210.

Barton V et al. Treatment of pediatric alopecia areata: A systematic review. J Am Acad Dermatol. 2022 Jun;86(6):1318-1334.

PRIOR STUDIES MTX IN CHILDREN

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