Olsen E A, Carson S C, Turney E A
Department of Medicine, Duke University Medical Center, Durham, NC 27710.
Arch Dermatol. 1992 Nov;128(11):1467-73.
Thirty-two patients with mild to extensive alopecia areata, including 16 patients with alopecia totalis or universalis, entered a randomized, controlled trial of a 6-week taper of prednisone followed by either 2% topical minoxidil or vehicle applied three times daily for an additional 14 weeks. The results of this study were compared with an open trial of 48 patients with alopecia areata treated with a similar taper of prednisone with concomitant 2% topical minoxidil applied twice daily. Only terminal hair growth was considered and was quantitated as 1% to 24%, 25% to 49%, 50% to 74%, and 75% to 100%: only those with more than 25% terminal hair regrowth were considered to have had an objective response.
At the end of 6 weeks of prednisone, 47% (15/32) of patients had more than 25% regrowth, including nine of 20 patients who had had at least 75% hair loss at baseline. Side effects of prednisone were primarily weight gain and mood changes/emotional lability. At 3 months, six of seven minoxidil-treated patients vs one of six vehicle-treated patients who had an objective response to prednisone maintained or augmented this hair growth: at the 20-week visit, these numbers were three of seven and zero of four patients, respectively. In the open trial, objective hair growth with prednisone was 30%, related to the extent of hair loss at baseline, and this growth persisted in more than 50% of patients at 6 months with the use of 2% topical minoxidil.
A 6-week taper of prednisone offers potential for more than 25% regrowth in 30% to 47% of patients with alopecia areata with predictable and transient side effects. Two percent topical minoxidil three times daily appears to help limit poststeroid hair loss.
32例轻度至广泛性斑秃患者，其中包括16例全秃或普秃患者，进入一项随机对照试验，先进行为期6周的泼尼松逐渐减量治疗，随后每天3次外用2%米诺地尔或赋形剂，持续14周。本研究结果与一项开放试验进行比较，该开放试验纳入48例斑秃患者，采用类似的泼尼松逐渐减量方案并同时每天2次外用2%米诺地尔。仅考虑终毛生长情况，并将其量化为1%至24%、25%至49%、50%至74%以及75%至100%:只有终毛再生超过25%的患者才被视为有客观反应。
泼尼松治疗6周结束时，47%（15/32）的患者再生毛发超过25%，其中包括20例基线时至少脱发75%的患者中的9例。泼尼松的副作用主要为体重增加以及情绪改变/情绪不稳定。3个月时，7例对泼尼松有客观反应的米诺地尔治疗患者中有6例维持或增加了毛发生长，而6例赋形剂治疗患者中只有1例如此；在第20周就诊时，上述数字分别为7例中的3例和4例中的0例。在开放试验中，泼尼松治疗后客观毛发生长率为30%，与基线时脱发程度有关，并且在6个月时，超过50%的患者使用2%外用米诺地尔可使这种生长得以持续。
对于30%至47%的斑秃患者，为期6周的泼尼松逐渐减量治疗有使再生毛发超过25%的潜力，且副作用可预测且短暂。每天3次外用2%米诺地尔似乎有助于减少激素停用后的脱发。
