Corticosteroids in the Treatment of Alopecia Totalis: Systemic Effects

Fifteen patients with alopecia totalis (AT) or alopecia universalis (AU) were treated with combined topical, intralesional, and oral corticosteroids. All or virtually all scalp hair has regrown on seven patients, and they have been able to discontinue oral corticosteroids without recurrence of AT or AU for periods of three months to 7½ years, with an average remission of 32 months. Two additional patients are currently receiving 5 mg of prednisone every two days. Using topical and intralesional corticosteroids in more resistant areas allowed for more rapid lowering of oral doses and thus side effects were minimized. In view of the usually nearly hopeless prognosis for AT and AU and the results reported here, a trial course of topical, intralesional, and oral corticosteroid treatment would seem to be reasonable for highly motivated patients.