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Use of oral corticosteroids in the treatment of alopecia areata
  1. Ben Jie Cowley,
  2. Jiawen Dong
  1. School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK
  1. Correspondence to Ben Jie Cowley, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; bjc56{at}cam.ac.uk

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Clinical bottom lines

  • Oral corticosteroid pulse therapy may be a safe and effective treatment for alopecia areata (Grade B).

  • Systemic corticosteroids must be used with caution in children due to the risk of avascular necrosis of the hip and other serious side effects (Grade C). A pulsed regimen may reduce the risks associated with long-term steroid use in a paediatric/young adult cohort.

Scenario

A 7-year-old girl is seen in paediatric clinic for review of her alopecia areata (AA). Topical corticosteroids have thus far proven ineffective at stimulating hair regrowth and the consultant is considering other possible treatments for her. He mentions that oral corticosteroids may be a possibility; however, he is unsure of the evidence supporting their use.

Structured clinical question

In children suffering from alopecia areata (AA; patients), does the use of oral corticosteroids (intervention) stimulate prolonged hair regrowth (outcome)?

Literature search methods

Cochrane Library: ‘alopecia areata’ AND ‘oral corticosteroid’)—1 result, 1 relevant.

PubMed: ‘alopecia areata’ AND ‘oral corticosteroids’—45 results, 13 relevant. 1 relevant result irretrievable and excluded.

Searches conducted in December 2018.

Commentary

AA is a chronic, autoimmune, non-scarring alopecia …

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