What is the efficacy of methotrexate for the treatment of alopecia areata?

Updated: Aug 06, 2020
  • Author: Chantal Bolduc, MD, FRCPC; Chief Editor: Dirk M Elston, MD  more...
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Joly [44] reported 22 patients with long-standing, severe alopecia areata who responded well to methotrexate, with or without systemic corticosteroids. A 2016 study suggests that long-term maintenance treatment is usually required to maintain hair growth. [45] A 2019 meta-analysis including both adults and children showed that the response rate tends to be better in adults compared with children (cosmetically acceptable regrowth 70% vs 45%; complete regrowth 45% vs 12%). [46] Relapse was seen in 50% of adults and 30% of children with dose reduction or discontinuation of treatment. Adverse events, mostly increased liver enzymes, GI symptoms, and CBC count anomalies, were seen in 25% of patients. There was an average of 3 months before regrowth began, and complete regrowth could be seen after 10 months. [46] Risks versus benefits must be carefully weighed before initiating methotrexate, and the patient must be warned about the high risk of recurrence if treatment is reduced or discontinued as this is a significant source of distress.

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