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corticosteroid treatment of alopecia areata overview

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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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