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Topical
corticosteroids for alopecia areata
Corticosteroids are probably the most popular form of treatment
for patchy alopecia areata. Steroids can be administered in four
different ways; topically as a cream or lotion, intralesionally
as local injections into the bald patches, and systemically either
as injections into a muscle or taken orally. These different methods
of application vary in their potency. Note that the corticosteroids
used are not anabolic steroids! Synthetic corticosteroids are mimics
of hormones made by the adrenal glands and these steroidal hormones
have a very different set of actions compared to anabolic steroids.
Topical creams are available with several different commercial
trade names and with different concentrations of steroids from 0.05
to 0.2%. They are applied only to the regions of hair loss and they
are the mildest form of steroid treatment. Typically, dermatologists
will try a milder form of treatment before attempting to use stronger
forms with their greater potential for side effects.
Response to topical steroids in therapeutic trials has been mixed.
Reports of nearly 100% response for prepubertal children have been
reported alongside a response rate of just 33% in adults in a double
blind study (Pascher 1970). Response to corticosteroids is more
likely the shorter the time period alopecia areata has been present.
Hair regrowth is not always immediate with reports of delay up to
3 months before hair regrowth was noticeable.
Side effects of topical steroids include folliculits (that can
be persistent, but not irreversible), acne outbreaks, local atrophy
where the cream is applied and very occasionally hypertrichosis.
If doses of topical steroids are too high there is a small risk
of systemic absorption and the potential associated side effects.
Intralesional
injection of corticosteroids
Intralesional steroid injection are a very popular compromise
between topical application and systemic use. It involves the injection
of a steroid solution (usually triamcinolone or kenalog) just below
the epidermis. It takes a steady hand to do this as injection just
a millimeter too deep will render the steroids much less effective.
The intention is to get as much of the steroid directly to the root
of the affected hair follicles where the associated inflammatory
infiltrate is present. Some clinics use compressed air guns to "inject"
the steroids which is much faster and usually less painful. depending
on the extent of hair loss there may be a need for numerous injections
over the bald regions. It can take up to 2 months before noticeable
hair growth develops (Porter 1971). Use of steroid injections is
a popular form of treatment for eyebrow hair loss.
Side effects can include pain from the injections and atrophy
of the skin around the injection site. This atrophy is usually reversible
unless the region has been repeatedly injected over time. Again,
there is a risk of systemic absorption if injected doses are too
high and/or too frequent with all the associated side effects.
Systemic
corticosteroids for alopecia areata
Systemic application of steroids is the most powerful form of corticosteroid
treatment. It can be done either by giving injections into a muscle
or more frequently by taking it orally. Systemic treatment is the
most potent and most effective form of steroid use. almost all patients
show some form of hair growth response (Kern 1973). However, systemic
use of steroids have been shown not to alter the long term prognosis
for alopecia areata. The steroids either promote a temporary regrowth
of hair and subsequent relapse when the treatment is stopped, or
systemic steroids just help bring forward a spontaneous recovery.
For this reason, and the need to get people off systemic steroid
use as soon as possible, this form of treatment is frequently used
in conjunction with something else to help maintain the regrowth
when systemic steroid treatment is stopped.
Systemic corticosteroid treatment is usually only a treatment
of last resort because of the potential for serious side effects.
Systemic corticosteroid use is generally limited to just a few weeks
of use before it must be stopped. Side effects include weight gain,
acne outbreaks, menstrual problems, mood swings, migraines, cataracts
and other eye complications, stunted growth in children, osteoporosis,
high blood pressure, and/or diabetes.
Corticosteroid treatment of alopecia areata overview references
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A, Labarthe MP, Engelhardt E, Feldmann R, Salomon D, Saurat JH.
Pulse methylprednisolone therapy for severe alopecia areata: an
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AS, Abahussein AA, Okoro A. Severe alopecia areata treated with
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VK, Muralidhar S. Treatment of widespread alopecia areata in young
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VK. Pulsed administration of corticosteroids in the treatment
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RJ, Kern F, Blizzard RM. Prednisone therapy for alopecia areata.
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