Poor long term outcome of severe alopecia areata in children treated with high dose pulse corticosteroid therapy

Conflicts of interest: none declared. Sir, Alopecia areata (AA) occurring before puberty is associated with a poorer prognosis than adult AA.1, 2 It is more likely to have a chronic evolution and to worsen over time.2 Treatment with boluses of methylprednisolone (MPBT) is currently used to treat this T‐cell mediated auto‐immune disease. It is considered as an effective and well‐tolerated treatment for extensive patchy AA.3 However, despite the tendency for a chronic evolution of AA occurring before puberty, long‐term assessment of this therapy to the best of our knowledge has not been reported. The objective of this cross sectional study was to assess the long‐term effectiveness of MPBT on severe AA occurring before puberty. The 12 consecutive patients aged between 1 and 16 years who had been treated with MPBT between January 1999 and December 2005 were asked to come for a visit. The treatment was done according to Kiesch et al.4 All patients were systematically examined before and one month after the end of the therapy. Long‐term assessment was carried out between January 2006 and March 2007. The short term and long term outcomes were measured according to the following criteria: good if regrowth was better than 60%, moderate if between 30 and 60% and bad below 30%, when compared to baseline photographs obtained at the first MBPT course.