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      Early Intervention with High-Dose Steroid Pulse Therapy Prolongs Disease-Free Interval of Severe Alopecia Areata: A Retrospective Study

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          Abstract

          Background

          Spontaneous recovery of severe alopecia areata is rare and the condition is difficult to treat.

          Objective

          The aim of this study is to investigate and compare the effects and safety of steroid pulse therapy between oral and intravenous administrations between 1999 and 2010 at the Department of Dermatology, National Cheng Kung University Hospital.

          Methods

          Data were retrospectively retrieved. A satisfactory response was defined as more than 75% hair regrowth in the balding area.

          Results

          A total of 85 patients with more than 50% hair loss were identified and treated, with an overall satisfactory response rate of 51.8%. The mean follow-up time was 37.6 months, with a relapse rate of 22.7%. Patients with alopecia areata (hereafter, AA) of recent onset within one year showed higher response rates ( p<0.001) and lower relapse rates compared to patients with AA persisting for more than 1 year. Further, even in patients with alopecia totalis, alopecia universalis or ophiasis type, early treatment resulted in a satisfactory response rate of 47% among the treated patients. In general, oral therapy was as effective and well-tolerated as intravenous therapy.

          Conclusion

          The response rate is determined by disease severity and time of intervention, not by the administration form of steroid pulse therapy. Oral steroid pulse therapy can be considered as the first-line treatment for patients with severe AA of recent onset within one year.

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          Most cited references13

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          Alopecia areata investigational assessment guidelines--Part II. National Alopecia Areata Foundation.

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            Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis.

            Alopecia areata (AA) is an autoimmune disease that presents as nonscarring hair loss, although the exact pathogenesis of the disease remains to be clarified. Disease prevalence rates from 0.1% to 0.2% have been estimated for the United States. AA can affect any hair-bearing area. It often presents as well demarcated patches of nonscarring alopecia on skin of overtly normal appearance. Recently, newer clinical variants have been described. The presence of AA is associated with a higher frequency of other autoimmune diseases. Controversially, there may also be increased psychiatric morbidity in patients with AA. Although some AA features are known poor prognostic signs, the course of the disease is unpredictable and the response to treatment can be variable. Part one of this two-part series on AA describes the clinical presentation and the associated histopathologic picture. It also proposes a hypothesis for AA development based on the most recent knowledge of disease pathogenesis. After completing this learning activity, participants should be familiar with the most recent advances in AA pathogenesis, recognize the rare and recently described variants of AA, and be able to distinguish between different histopathologic stages of AA. Copyright (c) 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
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              Alopecia areata: a long term follow-up study of 191 patients.

              The prognosis of alopecia areata (AA) is difficult to predict. Few studies report long-term follow-up of AA patients. The purpose of this study is to better assess the long-term evolution of AA and the possible relationship between disease severity and treatment response with long-term prognosis. One hundred ninety-one patients with AA who presented with a new diagnosis of AA between 1983 and 1990 were subsequently contacted by phone. Patients were queried regarding current disease status, treatments, and disease course. Severity of AA at first consultation ranged from mild (128 patients) to severe (63 patients). Fifty-five of 191 patients were affected by concomitant autoimmune or related inflammatory disease. Sixty-six of 191 patients were presently disease free (follow-up duration, 15-22 years; mean 17.74 years). These include 41 of 60 patients with S1 disease (68.3%), 22 of 68 patients with S2 disease (32.3%), 1 of 11 patients with S3 disease (9%), 1 of 14 patients with S4 disease (7.1%), and 1 of 11 patients with alopecia totalis (AT) (9.1%). Sixty-nine of 191 patients (36-1%) were presently affected by AT or alopecia universalis. There was a statistically significant tendency of severe patterns of AA to worsen over time. In children, 18 of 39 (13 with or =S3 disease) with AA had developed AT or alopecia universalis at long-term follow-up. In children, however, this trend was not statistically significant. Patients with severe AA who responded to topical immunotherapy seem to have a better prognosis than nonresponders. Follow-up was only performed by phone. Severity of AA at time of first consultation is an important prognostic factor. Response to therapy (topical immunotherapy) may be associated with better prognosis. In children, the prognosis is worse; our study found that AA worsens over time.
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                Author and article information

                Journal
                Ann Dermatol
                Ann Dermatol
                AD
                Annals of Dermatology
                Korean Dermatological Association; The Korean Society for Investigative Dermatology
                1013-9087
                2005-3894
                November 2013
                30 November 2013
                : 25
                : 4
                : 471-474
                Affiliations
                [1 ]Department of Dermatology, National Cheng Kung University, College of Medicine, Tainan, Taiwan.
                [2 ]Institute of Clinical Medicine, National Cheng Kung University, College of Medicine, Tainan, Taiwan.
                [3 ]Department of Dermatology and Allergy, Technische Universität München, Munich, Germany.
                Author notes
                Corresponding author: WenChieh Chen, Department of Dermatology and Allergy, Technische Universität München, Biedersteiner Str. 29, Munich 80802, Germany. Tel: 49-89-4140-3185, Fax: 49-89-4140-3502, wenchieh.chen@ 123456lrz.tum.de
                Article
                10.5021/ad.2013.25.4.471
                3870216
                24371395
                849ccb70-682e-45dc-8c0b-2d4c9c13bb32
                Copyright © 2013 The Korean Dermatological Association and The Korean Society for Investigative Dermatology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 04 May 2012
                : 17 November 2012
                : 11 December 2012
                Categories
                Original Article

                Dermatology
                alopecia areata,corticosteroids,pulse drug therapy,treatment
                Dermatology
                alopecia areata, corticosteroids, pulse drug therapy, treatment

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