Sometimes systemic corticosteroids are used to treat alopecia areata

Alopecia areata hair loss information for men and women
Alopecia Areata 
Alopecia Areata Biology
Alopecia Areata Treatments

  Systemic Injections of Corticosteroids for Alopecia Areata
 

Alopecia areata is a recurrent form of hair loss disease. Although the disease is non-life threatening and reversible, it may cause major sociopsychological problems. Of late, research has yielded valuable insights into the nature of the disease, but the exact pathogenesis of the malady is yet unknown, as a result of which neither accurate treatment nor proper remission has been possible. Early diagnosis and intervention is vital and patients must be supported to continue with the prolonged treatment required for the reduction of the disease symptoms.

Alopecia areata has been identified as an autoimmune disease and treatment too, is therefore chiefly immunomodulatory by nature. In the patchy form of alopecia areata, corticosteroids are the chief drugs used for treatment. It has been found that T-cells play a significant role in the development of patchy alopecia areata. Corticosteroids are effective in inhibiting the activation of T-lymphocytes and thus help in controlling the disease. Coricosteroids also help in reducing the inflammation and pain that may sometimes be associated with alopecia areata.

Use of Corticosteroids

Corticosteroids have been used in various forms in the treatment of alopecia areata. They may be used topically in the form of cream or lotion. Corticosteroids can also be injected directly into the lesions as local injections or they can be used systemically where the drug is injected into the muscles or taken orally. Each of these methods has a different potency and varied success rates and side effects.

The systemic administration of corticosteroids – either locally or through injection in the muscles, is the most effective course of treatment. But it is also accompanied by different side effects, which deter patients and doctors from pursuing this line of treatment for a long time. Besides, corticosteroids temporarily promote hair growth but once the treatment is stopped, there may be relapse of the condition.

Corticosteroids are generally used with the extent of the disease and the age of the patient in mind. The exact strength and dose of the medicine has to be determined based on these factors. A low dose of corticosteroids is usually 10mg/day. 10-20mg/day constitutes a medium dose and above 20mg/day is said to be a very high dose. Caution should be exercised in using this drug for a period of three months or more as such long term use gives rise to undesirable side effects. Corticosteroids are therefore best used in milder forms of alopecia areata and preferably avoided in cases of extensive hair loss like alopecia totalis or alopecia universalis. Keeping in mind the potential hazards of the drug, corticosteroids should always be used under the supervision of a medical practitioner or a dermatologist. In addition, the drug should not be stopped abruptly; rather, doses should be gradually tapered off before complete discontinuation.

Success Rate of Systemic Corticosteroids

Corticosteroids have had varied response in the control of alopecia areata. Studies were conducted on 22 patients out of whom 4 had alopecia totalis, 2 had alopecia universalis and one had patchy hair loss. After being treated with cortisone acetate tablets, 16 out of 22 patients showed signs of hair regrowth within 3-6 months. It was seen that patients in whom the last episode of alopecia areata was a prolonged one or those who had alopecia areata in their adolescence, showed poor response to orally administered steroids or did not respond to the treatment at all. On discontinuation of therapy or administering very low doses, there was a recurrence of the disease.

Pulse Administration of Corticosteroids

In this, short intensive doses of corticosteroids are administered in single doses at intervals of a week or month. This therapy is used to minimize the side effects of this drug. No major side effects have been observed in pulse therapy. Sometimes patients may display symptoms like nausea, flush, headache, fatigue, palpitations, shortness of breath or giddiness in varying degrees.

Oral prednisone has also been tried as a treatment for alopecia areata. This mode of treatment also shows good results but the high dose of prednisone required for effective treatment may induce adverse side effects. Systemic administration of prednisone may avert this problem but the benefits of this course of treatment are low and there is also a higher rate of relapse of the disease. Systemic prednisone therefore has not proved successful either in the short term or in the long-term treatment of the disease.

Intramuscular Steroids

This is another available option in the treatment of alopecia areata. Here the steroid is injected either intravenously or through an intramuscular injection. On entering the body, the steroid blocks certain subsets of the T cells thereby promoting regrowth of hair. However, here too similar side effects may occur as in oral steroids.

The common side effects observed in such cases are:

  • Hyper tension or high blood pressure.
  • Diabetes or aggression of previously existing diabetes.
  • Suppression of the immune system.
  • Tendency towards thrombosis.

Because of such associated side effects, systemic steroids cannot be used for a prolonged period of time. For effective treatment of alopecia areata, doctors recommend a combination of therapies with topical, intralesional and oral corticosteroids.

Conclusion

Systemic steroids have been found to have only partial success in the control of alopecia areata. Neither can the benefits of this therapy be compared to other approaches in the control of the disease. Moreover, systemic steroids only suppress the underlying conditions and do not alter the course of the process. They promote regrowth of hair. However, unfavorable side effects do not permit prolonged use and once they are discontinued, a relapse of the disease occurs. Systemic corticosteroids should therefore be used strictly under the supervision of a medical practitioner and only when all other courses of treatment have been explored.



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