Treatment of Rapidly Progressive Alopecia Areata (≥25% Scalp) in Adults 18 and Older
This protocol addresses adults aged 18 or older who present with rapidly progressive alopecia areata
affecting 25% or more of the scalp (severity grade S2 or higher) in the initial, acute phase,
where spontaneous resolution is not expected.
Clinical Scenario
The patient is an adult (18 or older) with an initial (acute) episode of alopecia areata that is
advancing rapidly, with scalp involvement at the S2 grade or above. Patients who have a high
likelihood of spontaneous cure are excluded from this protocol.
Treatment Approach
Management in this setting involves systemic corticosteroid therapy; the protocol defines
the specific conditions under which each treatment option is appropriate — the complete
regimen, sequencing, and criteria are available in the full protocol below.
Treatment goal: ≥75% hair recovery of the scalp at 6 months
References
- It may be performed in adults with rapidly progressive S2 or higher initial-phase AA.
- Rapidly progressive AA patients with spontaneous cure tendency are excluded.
- Patients with a high possibility of spontaneous cure should be excluded.
- It may be performed in rapidly progressive S2 or higher initial-phase AA patients.
- Methylprednisolone at 500 mg/day was intravenously infused for three consecutive days in 139 patients with multiple AA, AT, or AU, and follow-up was performed for 6–70 months.
- As the recurrence rate after discontinuation is high, this therapy should be considered only in patients resistant to other standard treatments, such as corticosteroid application/injection.
- In another study, prednisolone at 40 mg/day was administered to 32 patients with a mean disease duration of 6.7 years for 1 week, and the dose was gradually decreased over 6 weeks.
- In 88% of patients with an alopecia area of ≤50% of the scalp within 6 months after the onset of alopecia, ≥75% hair recovery was achieved.
DOI: 10.14924/dermatol.134.2491
View source ↗