Division of Pediatric Dermatology, Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia.
University of Belgrade, School of Medicine, Belgrade, Serbia.
Dermatol Ther. 2019 Nov;32(6):e13092. doi: 10.1111/dth.13092. Epub 2019 Oct 18.
There is no universally accepted treatment for severe pediatric alopecia areata (AA). This prospective study comprised 73 patients (aged 1-18 years) with severe AA (>30% of scalp surface area): 37 received 1-day intravenous dexamethasone pulses (1-DP) and 36 received 3-day pulses (3-DP), monthly, for 6-12 months. Also, all patients applied topical clobetasol propionate under plastic wrap occlusion. Patients achieving >50% regrowth were considered good responders (GR). All patients reached short term, while 65/73 were available for the long-term follow-up (mean 33.3 ± 15.3 vs. 27.7 ± 14.3 months, 1-DP and 3-DP, respectively). Relapses during therapy were more frequent in 1-DP group. 3-DP patients were more frequently GR in comparison with 1-DP. 3-DP patients with disease duration <6 months had better outcomes. Patients without Hashimoto thyroiditis (HT) had 9.8-fold higher chance of being GR in comparison with HT patients. The best results were achieved in AA plurifocalis (AAP). No patient had severe short-term side-effects. At the long-term follow-up, 67% of 3-DP patients had stable results. Only 14.2% AAP patients experienced relapses. Patients had no long-term side-effects. 3-DP were more efficacious than 1-DP. Short disease duration and no HT were good prognostic factors. 3-DP protocol is well-tolerated, with beneficial effects and long-lasting results in severe pediatric AA.
目前，针对儿童重症斑秃（AA），尚无广泛认可的治疗方法。本前瞻性研究纳入 73 例重症 AA 患儿（年龄 1-18 岁，头皮受累>30%）：37 例患儿接受 1 天静脉内地塞米松脉冲治疗（1-DP），36 例患儿接受 3 天脉冲治疗（3-DP），每月 1 次，持续 6-12 个月。所有患儿均局部外用氯倍他索丙酸酯，并用塑料膜封包。>50%毛发再生的患者被认为是良好反应者（GR）。所有患者均达到短期疗效，65/73 例患者可进行长期随访（1-DP 和 3-DP 分别为 33.3±15.3 和 27.7±14.3 个月）。1-DP 组在治疗期间更易复发。与 1-DP 相比，3-DP 患者更易达到 GR。疾病持续时间<6 个月的 3-DP 患者疗效更好。与 HT 患者相比，无桥本甲状腺炎（HT）的患者成为 GR 的可能性高 9.8 倍。多灶性 AA（AAP）患者的疗效最佳。所有患者均未出现严重的短期不良反应。长期随访时，67%的 3-DP 患者疗效稳定。仅有 14.2%的 AAP 患者复发。所有患者均无长期不良反应。与 1-DP 相比，3-DP 更有效。疾病持续时间短、无 HT 是良好的预后因素。3-DP 方案耐受性良好，对儿童重症 AA 具有良好的疗效和持久的效果。
