Retrospective Analysis of Systemic Corticosteroids for Alopecia Areata in Pediatric Patients

Abstract

Background: Therapy for alopecia areata (AA) in a pediatric patient population is challenging and controversial. Common treatments include a variety of topical or injected agents. Systemic steroid treatment in children is controversial due to concern of negative side effects. The purpose of this study was to evaluate the efficacy and safety of systemic corticosteroid therapy for the treatment of AA in pediatric patients. Methods: This retrospective chart review included patients treated with standard courses of oral corticosteroids (3-week taper starting at 1 mg/kg) for AA who were managed by the Dermatology Section at the Children’s Hospital of Philadelphia between 2015 and 2018. The following data was extracted from patients’ charts: Severity of disease measured by Severity of Alopecia Tool (SALT) scores for AA, treatment regimen, duration of treatment and number of steroid courses, side effects, age, gender, and weight percentiles. SALT scores and weight percentiles were recorded at pretreatment as well as at 3 months and 6 months after initiation of treatment. SALT scores, when available, were additionally recorded at 9, 12, and 15 months after initiation of treatment. Results: 82 pediatric subjects were included in the study. Subjects were grouped according to severity at pretreatment with systemic corticosteroids with < 50% SALT as mild and > 50% SALT as Severe. Subjects in the > 50% SALT score group followed at 5 intervals (pre-treatment, 3 months, 6 months, 9 months, 12 months, 15 months) showed statistically-significant improvement/lowering of SALT scores, while subjects in the < 50% SALT group did not over the same time period. No serious adverse side effects were documented in any subjects treated. However, 67 patients of a total of 82 studied relapsed during the time intervals observed. The average time to relapse was 21.9 weeks after initiation of treatment (standard deviation: 16.76 weeks; range: 4.71 to 73.43 Additionally, weight percentiles a statistically significant baseline. Conclusion: Patients with baseline SALT scores ≥ 50 improved significantly after a course of systemic steroids but relapsed on average 4-5 months later with concomitant weight gain.