Children's Severe Alopecia Areata Treatment 'Well-Tolerated' in Trial

Paediatric Alopecia Areata, where the autoimmune disorder which causes sudden-onset patchy hair loss presents in children under 18 years of age, currently has no widely recommended or official treatment options.

Findings from new Serbian research involving 73 patients aged between 1 and 73 years old was published in the Dermatologic Therapy medical journal in October 2019.

Each participant had been professionally diagnosed with severe Alopecia Areata covering more than 30 per cent of their scalp, and two different therapies were trialled over the course of 6 to 12 months, to help shed light into which forms of treatment may benefit young people with this type of shedding.

Dexamethasone pulse therapy

This prospective study, funded by the Ministry of Education and Science of the Republic of Serbia, comprised 73 patients (aged 118 years) with severe Alopecia Areata where it affected more than 30 per cent of the scalp's surface.

Of this group, 37 received 1‐day intravenous dexamethasone pulses (1‐DP), whilst 36 were administered 3‐day pulses (3‐DP) each monthly for between 6 and 12 months. All patients took part for 6 months, whilst 65 of the 73 were studied until the 12 month mark.

Dexamethasone is a corticosteroid, usually taken orally, for the treatment of inflammatory conditions, ulcerative colitis, arthritis, lupus, psoriasis and certain breathing disorders.

In addition to their allocated pulse therapy, all the participants in each group also applied topical clobetasol propionate under an occlusive plastic wrap. This is another steroid, generally used as a cream, applied topically to reduce inflammation and irritation in cases of skin conditions, including psoriasis, eczema, dermatitis, lichen planus and discoid lupus erythematosus.

Trial findings

The trial researchers considered those who achieved hair regrowth results of 50 per cent or above to be 'good responders' (GR).

At the six month stage, the group receiving 3‐DP was found to have more success than the 1-DP group which saw the most frequent relapses.

Those 3-DP patients whose Alopecia Areata had been present for six months or less, saw the best outcomes. The 3-DP group also came out on top at the long‐term, 12 month follow‐up, as 67 per cent had "stable results".

No patients reported any severe short‐term nor any long-term side effects from the treatment.

Interestingly, given it is well-established that people who have one autoimmune disorder are more likely to develop others, the findings state that the children who did not also have Hashimoto thyroiditis (HT) - an autoimmune disease where the immune system attacks the thyroid - were 9.8 times more likely to be a 'good responder' to the treatment than those with the condition.

It was therefore concluded that "Short disease duration and no HT were good prognostic factors. 3‐DP protocol is well‐tolerated, with beneficial effects and long‐lasting results in severe paediatric AA".

Whilst these small-scale results show promise, there is still a long road of testing ahead before this type of Alopecia Areata treatment is able to be submitted for the appropriate MHRA and FDA designations it requires to be made widely available.

For now, those aged 16 and over with scalp-only Alopecia Areata can visit a hair loss clinic for a professional consultation and suitable treatment recommendations. These often involve the topical solution high strength minoxidil, which is currently MHRA-licensed and FDA-approved for the treatment of genetic hairloss.

Under 16s with any form of Alopecia Areata, or people of any age with forms which also affect other areas of the body, such as Alopecia Totalis or Alopecia Universalis, should seek advice from their GP who can refer them to a dermatologist, if necessary, to discuss hospital-based treatments such as immunotherapy.

Emotional and practical support in the form of psychodermatology and free real-hair wigs for children and young adults affected by medical hair loss, including the various forms of autoimmune alopecia, are also options worth considering.