Van Anh Tran Thi, Lan Anh Tran, Anh Minh Ha, Van Thuong Nguyen, Minh Phuong Pham Thi, Thi Phuong Trinh, Minh Trang Trinh, Huu Nghi Dinh, Thanh Tung Vu, Huyen My Le, Hau Khang Tran, Gandolfi Marco, Satolli Francesca, Feliciani Claudio, Tirant Michael, Vojvodic Aleksandra, Lotti Torello
National Hospital of Dermatology and Venereology, Hanoi, Vietnam.
Unit of Dermatology, University of Parma, Parma, Italy.
Open Access Maced J Med Sci. 2019 Jan 23;7(2):200-203. doi: 10.3889/oamjms.2019.004. eCollection 2019 Jan 30.
Treatment of severe alopecia areata remains very difficult, especially in alopecia areata totalis and alopecia areata universalis. Methotrexate is known to be effective in the treatment of severe and chronic autoimmune disorders.
To assess the effectiveness and safety of MTX in combination with mini pulse dose of methylprednisolone in the treatment of severe alopecia areata.
The open, uncontrolled study compared pre-treatment and after-treatment. Thirty-eight patients (age 16-64) with severity AA (SALT score > 50 %) visiting National hospital of Dermatology and Venereology from April-2004 to September-2015 were enrolled. All patients received oral methylprednisolone 24mg/day for 3 consecutive days of a week in combination with oral MTX 7,5 mg weekly. This regimen is maintained up to 12 weeks and follow-up until to 6 months.
After 6 months, 60.5% of patients show complete hair growth (good response) and 18.4% shows the medium response. There is a significant SALT score reduction: mean baseline SALT score 84.39 ± 17.03 compared to mean post-treatment SALT score 24.19 ± 29.42. Good clinical improvement noted in after 3 months. We do not observe any side- effects related to oral MTX and oral methylprednisolone, and no patients had to withdrawal treatment due to side- effects.
Combination Methotrexate and mini pulse dose of methylprednisolone are effective and safe in treatment severity alopecia areata.
重度斑秃的治疗仍然非常困难，尤其是全秃和普秃。已知甲氨蝶呤在治疗重度和慢性自身免疫性疾病方面有效。
评估甲氨蝶呤联合小剂量脉冲式甲基泼尼松龙治疗重度斑秃的有效性和安全性。
这项开放性、非对照研究比较了治疗前和治疗后的情况。纳入了2004年4月至2015年9月期间到国家皮肤性病医院就诊的38例（年龄16 - 64岁）重度斑秃患者（严重斑秃工具评分[SALT评分] > 50%）。所有患者每周连续3天口服甲基泼尼松龙24mg/天，并联合每周口服甲氨蝶呤7.5mg。该方案持续12周，并随访至6个月。
6个月后，60.5%的患者显示毛发完全生长（良好反应）且18.4%显示中度反应。SALT评分有显著降低：治疗前平均SALT评分为84.39 ± 17.03，治疗后平均SALT评分为24.19 ± 29.42。3个月后观察到良好的临床改善。未观察到与口服甲氨蝶呤和口服甲基泼尼松龙相关的任何副作用，且没有患者因副作用而不得不停止治疗。
甲氨蝶呤与小剂量脉冲式甲基泼尼松龙联合治疗重度斑秃有效且安全。
