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J Dermatol. 2019 Apr 10. doi: 10.1111/1346-8138.14871. [Epub ahead of print]

Predictive factors of response to pulse methylprednisolone therapy in patients with alopecia areata: A follow-up study of 105 Japanese patients.

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Department of Dermatology, Shiga General Hospital, Shiga, Japan.
Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Fujisawa Dermatology Clinic, Kyoto, Japan.
Tanioka Dermatology Clinic, Kyoto, Japan.
Singapore Immunology Network (SIgN) and Institute of Medical Biology, Agency for Science, Technology and Research (A*STAR), Biopolis, Singapore City, Singapore.


Pulse corticosteroid therapy is effective for alopecia areata (AA) in the early stage. The risk and efficacy of this therapy for patients with several backgrounds, however, remains controversial. To explore the predictive factors of the response and risk factors of this therapy, data from 105 AA patients treated with methylprednisolone (500 mg) i.v. for 3 days consecutively in our facility were retrospectively analyzed. Among good responders, longer time from the onset to therapy was correlated with longer time required for hair regrowth (P = 0.037, n = 27). Multivariate models demonstrated that "severity", "relapse" and longer "duration from the latest onset" were significantly and independently associated with poorer outcome (P < 0.01). "History of atopic dermatitis (AD)" was also associated with poorer outcome, but this correlation could be explained by the effect that duration from the latest onset of AA was longer among participants with AD. We propose that earlier initiation of pulse corticosteroid therapy is preferable for better outcome of AA, particularly among patients with AD. Clinicians should be mindful of the occurrence of mild adverse effects in the elderly patients.


adverse effects; alopecia areata; atopic dermatitis; methylprednisolone pulse therapy; multivariate regression analysis


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