ABSTRACT
Background: Alopecia areata [AA] is one of the most common autoimmune disorders and its severe types are resistant to almost all conventional therapies. Methotrexate [MTX] has been used as an adjunctive therapy in some autoimmune disorders and has been proposed to be effective in the treatment of severe alopecia areata both as a monotherapy and in combination with corticosteroids
Aim of the study: was to evaluate the outcome and safety of MTX therapy in patients with severe forms of AA, whether as monotherapy or in combination with systemic or intralesional corticosteroids; and to assess therapeutic response according to sex, age, pattern of AA, disease duration and cumulative MTX dose
Methods: 28 patients were evaluated in a retrospective, non-controlled study, with alopecia areata in current or prior treatment with methotrexate to assess the therapeutic response according to sex, age, pattern of alopecia areata, disease duration, and cumulative dose of methotrexate as well as the use of systemic corticosteroids or other treatments, and drug safety
Results: 77.8%% of patients experienced a more than 50% regrowth rate, with the best responses observed in those with <5 years of disease progression [81%], age over 40 years [84.6%], male patients [80%], cumulative dose of methotrexate 1000-1500 mg, and multifocal alopecia areata [83.3%], patients receiving systemic corticosteroids in combination with methotrexate, 78.5% had greater than 50% regrowth, compared with 45.3% in those who used methotrexate alone. The therapeutic dose ranged from 10-25 mg/week. No patient had serious adverse effects. Relapse was observed in 35.4% of patients with more than 50% regrowth
Conclusion: methotrexate is a convenient and relatively inexpensive drug that could be used as a safe and well tolerated adjunctive therapy for severe alopecia areata although careful monitoring of adverse