Treatment of widespread alopecia areata in young patients with monthly oral corticosteroid pulse.

Sixteen patients up to 18 years of age with widespread alopecia areata (AA) were recruited for the study. They included 10 patients with extensive AA (> or = 40% loss of scalp hair and or more than 10 patches scattered over the scalp and body) and 3 each with alopecia totalis and circumscribed alopecia areata. Patients were divided into two groups. In group A, aged 12 to 18 years, patients received 300 mg of prednisolone in a monthly oral pulse; in group B, aged 3 to 11 years, patients received betamethasone sodium phosphate as soluble tablets or syrup equivalent to prednisolone 5 mg/kg body weight every month. The pulsed doses of corticosteroid were continued for a minimum of three doses or until cosmetically acceptable hair growth was obtained. All patients but one 5-year-old girl received a minimum of three doses. Excellent hair growth was obtained in 9 (60%) of 15 patients evaluated at 6 months. Four patients out of 13 (>12 month follow-up), including two each in group A and B, developed a localized relapse during mean follow-up of 16.4 and 33.7 months in group A and B, respectively. Side effects of pulsed corticosteroid were minimal and were recorded in two patients (transient giddiness and headache, epigastric burning in one each). We recommend pulsed doses of prednisolone as one of the modalities in the treatment of widespread AA in young patients, including children.