115 Successful Treatment of Alopecia Totalis/ Universalis by General PUVA Therapy Combined with Systemic and Topical Corticosteroids

M Yamashita, R Tsuboi, K Takamori1, H Ogawa. Dept. of Dermatology, Juntendo University School of Medicine, Urayasu Hospital1, Tokyo, Japan

Alopecia totalis/universalis (AT/AU) patients 15 years old or older, who visited Juntendo University Hospital from 1994 to 1998, were enrolled in this study. AT patients (108 cases) and AU patients (175 cases) were treated with one of four different regimens for more than six months, and the rate of efficacy, recurrence and adverse effects of each modality were compared. Group 1 (N=58) was treated with topical immunotherapy using SADBE; group 2 (N=85), with topical corticosteroids; group 3 (N=104), with systemic and topical corticosteroids; group 4 (N=36), with oral 8-methoxypsoralen and general UVA irradiation combined with systemic and topical corticosteroids. The therapeutic effects were quantitatively compared by scoring the degree of hair regrowth. The results indicated the following percentage figures for moderate and marked improvement in each group: group 1, 41.4% (15.5%); group 2, 37.6% (23.5%); group 3, 57.7% (43.3%); group 4, 72.2% (61.1%). Meanwhile, the recurrence rate was 66.6% for group 1, 30.0% for group 2, 35.6% for group 3 and 13.6% for group 4. The efficacy rate of groups 3 and 4 was superior to that of groups 1 and 2. Group 1 showed a low rate of marked improvement and a high recurrence rate, while group 4 showed a high rate of marked improvement and a low recurrence rate. Adverse effects caused by the application of topical and systemic corticosteroids were frequently observed in groups 2 to 4, but were improved after tapering the dose of corticosteroids. Among the four treatments tested, general PUVA therapy, combined with systemic and topical corticosteroids, is the best treatment both in terms of efficacy and recurrence rate, and is recommended as an excellent treatment for adult alopecia totalis/ universalis.