Mini-pulse oral dexamethasone combined with fixed-dose oral minoxidil in pediatric alopecia areata: a retrospective cohort study

Introduction: Alopecia areata is an autoimmune disorder causing non-scarring hair loss that frequently affects children. Management of moderate-to-severe pediatric disease remains challenging, and systemic treatment options for younger children are limited. We evaluated clinical outcomes and tolerability of oral dexamethasone mini-pulse therapy combined with fixed-dose oral minoxidil in children younger than 12 years. Methods: This retrospective cohort study included 35 children treated with oral dexamethasone on two consecutive days weekly for 12 weeks together with oral minoxidil 2 mg/day. Clinical records from January 2021 through December 2025 were screened, and the database was locked on August 15, 2026. Only patients with at least 9 months of follow-up after their final treatment cycle were included. Response was assessed using the Severity of Alopecia Tool (SALT). Results: After the first 12-week cycle, 21/35 patients (60.0%) achieved SALT50, 9/35 (25.7%) achieved SALT90, and 4/35 (11.4%) achieved SALT100. Mean SALT decreased from 60.3 ± 21.7 to 37.0 ± 30.7, with a mean change of −23.3 ± 15.1 points. Eleven first-cycle SALT50 nonresponders underwent a second cycle; 8/11 (72.7%) achieved SALT50, 2/11 (18.2%) achieved SALT90, and none achieved SALT100. Overall, 29/35 patients (82.9%) achieved a cycle-specific SALT50 response during at least one treatment cycle; this was a cumulative proportion rather than a uniform 12-week outcome. Mild adverse events occurred in 9 patients (25.7%), most commonly hypertrichosis (11.4%). Median post-treatment follow-up was 10.4 months (IQR 9.6–11.2). Conclusion: The combined regimen was associated with clinically meaningful SALT improvement and generally mild documented adverse events. Because of the retrospective uncontrolled design, causal efficacy and the independent contribution of oral minoxidil cannot be established. Prospective controlled studies are warranted.