117 INTRAVENOUS REPEATED PULSE METHYLPREDNISOLONE THERAPY FOR SEVERE ALOPECIA AREATA : AN OPEN STUDY OF 32 PATIENTS

P. Reygagne, Ph Assouly, C Jouanique, B Matard, H Bachelez, L Dubertret Sabouraud center and dermatology service (Pr Dubertret), Hopital Saint Louis, PARIS.

Background: Alopecia areata (AA) is probably an autoimmune disease. Available therapies include topical, intralesional, or systemic corticosteroids. Systemic pulse methylprednisolone therapy has been reported to be well tolerated and effective in patients with rapidly progressing AA with ongoing hair loss of less than 12 months duration. Objective: In order to research an improvement of those results, we performed a prospective open study to determine the efficacy of monthly repeated intravenous pulse of methylprednisolone. Methods: 500mg of methylprednisolone were administered 3 successive days every month for 3 months. 3 optional series of pulses were proposed to the partial responders after 3 months. 32 patients received 3 series of pulses between dec. 1999 and dec. 2000. All had an active or very active AA with a bald or a hair loss area exceeding 30% of the scalp for less than 1 year (3 months for most of them). They were 8 men and 24 women. Average age was 30 years (9-60 years). Results: No major side effects were observed. At 3 months of follow up, 15 patients had a 80 to 100% regrowth (47%) , 5 a partial regrowth (15%), 7 a stabilisation (22%), and only 5 an aggravation (16%). Results for 16 more patients and for 6 months of follow-up are pending. As during previous studies, patients with plurifocal AA showed the best regrowth. Several factors will be discussed concerning the response rate: age, type of AA, and delay from the onset to the treatment. Conclusion: Monthly repeated series of intravenous pulses of methylprednisolone over 3 months seem to be well tolerated and more effective than a single series in patients with acute extensive AA.