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Use of oral corticosteroids in the treatment of alopecia areata
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  • Published on:
    Latrogenic adrenal suppression, a risk not be to ignored
    • Elizabeth M Bayman, Paediatric registrar in endocrinology Royal Hospital for Sick Children, Edinburgh
    • Other Contributors:
      • Louise E Bath, Consultant paediatric endocrinologist
      • Amanda J Drake, Professor of epigenetics and metabolism / Honorary consultant in paediatric endocrinology

    Dear editor

    We write in response to the article "Use of oral corticosteroids in the treatment of alopecia areata" by BJ Cowley and J Dong, published in January's edition of the journal.(1)

    In this article, the authors present a summary of their literature search, concluding that oral corticosteroid pulse therapy may be a safe and effective treatment for sufferers of alopecia areata (AA). The authors highlight the risk of avascular necrosis of the hip with the use of corticosteroids, despite none of their cited studies reporting on this complication specifically.

    We would argue that iatrogenic adrenal suppression (AS) secondary to exogenous corticosteroid administration is also a noteworthy risk in these patients. Symptomatic AS has been well documented in the asthmatic population receiving daily inhaled corticosteroids, occasionally resulting in adrenal crisis and even sadly death. Whilst there is a good level of awareness of AS amongst some colleagues using high doses of daily steroids, for example in the induction phases of leukaemia treatment, AS is not confined to these children and is as pertinent to those receiving pulsed steroids for AA(2,3).

    In our centre we have had personal experience of looking after a child who required intubation and ventilation when they developed a viral illness and presented with hypotension and hypoglycaemia. They had received intralesional steroids to treat AA, which had caused severe adrenal sup...

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    Conflict of Interest:
    None declared.