COMBINATION TREATMENT WITH DEXAMETHASONE MINIPULSE AND
METHOTREXATE IN ALOPECIA AREATA- EFFECTIVENESS AND TREATMENT RELATED
ADVERSE EFFECTS
Alopecia areata (AA) is an autoimmune condition characterized by non-scarring hair loss.
The condition can significantly impact quality of life and self-esteem. Despite its prevalence,
there is no universally accepted treatment protocol, and numerous therapeutic approaches
have been explored. Among these, combination therapies have gained attention for
potentially enhancing efficacy and minimizing adverse effects.
A systematic review was conducted focusing on the combination treatment of
dexamethasone minipulse (DMP) and methotrexate (MTX) in the management of AA,
evaluating its effectiveness and associated treatment-related adverse effects. PubMed,
Cochrane Library, and Google Scholar were searched for studies published up to July 2023
using keywords such as "Alopecia areata," "dexamethasone minipulse," "methotrexate,"
"combination therapy," "effectiveness," and "adverse effects." Inclusion criteria were
randomized controlled trials (RCTs), observational studies, and cohort studies that
evaluated the combination treatment of DMP and MTX in AA. Exclusion criteria included case
reports, reviews, and studies lacking sufficient data on efficacy or adverse effects. Multiple RCTs demonstrated that the combination of DMP and MTX significantly improves
hair regrowth in AA patients compared to monotherapy. One RCT reported a 60%
improvement in the combination group versus 35% in the MTX alone group.Observational
Studies: A large cohort study showed a response rate of 70% in patients receiving
combination therapy, with significant improvement noted within 12 weeks of treatment
initiation. Studies with follow-up periods exceeding 12 months indicated sustained hair
regrowth in patients treated with the combination therapy, with lower relapse rates
compared to monotherapy. Patients treated with DMP and MTX showed a significant
reduction in SALT scores, indicating a greater percentage of hair regrowth. One study
reported a mean SALT score reduction from 60 to 20 after 24 weeks of combination
therapy. Increased blood glucose levels and weight gain were common, though less
pronounced than with continuous high-dose corticosteroid therapy. Mood swings,
insomnia, and anxiety were reported in a minority of patients, generally resolving with
dose adjustment or discontinuation. Nausea, vomiting, and oral ulcers were frequent but
manageable with folic acid supplementation and dose adjustments. Mild leukopenia and
anemia were observed in some patients, necessitating regular blood monitoring. Elevated
liver enzymes were noted in a small percentage of patients, which resolved with temporary
discontinuation or dose reduction of MTX.
The combination therapy's immunosuppressive effects increased susceptibility to
infections, though no severe infections were reported in the reviewed studies. The
potential for cumulative toxicity necessitates careful patient selection and regular
monitoring, particularly in long-term treatment regimens.
The combination of dexamethasone minipulse and methotrexate appears to be an effective
treatment for alopecia areata, offering significant improvement in hair regrowth compared
to monotherapy. The dual mechanism—DMP's anti-inflammatory action and MTX's
immunomodulatory effect—may provide a synergistic benefit, addressing different aspects
of the autoimmune pathophysiology of AA. However, the combination therapy is not
without risks. The incidence of adverse effects, although generally manageable,
underscores the need for close monitoring and individualized treatment plans. Regular
follow-ups and appropriate dose adjustments are critical to minimizing adverse effects
while maximizing therapeutic outcomes.
Combination therapy with dexamethasone minipulse and methotrexate is a promising
approach for treating alopecia areata, demonstrating enhanced efficacy in hair regrowth
and acceptable safety profiles. Further large-scale, long-term studies are warranted to
establish standardized protocols and optimize patient outcomes.68.6%) and extended
activities of daily living (n=125, 80.1%) were affected. Patients with Early presentation (p=0.000), early intervention (p=0.013), macular-on (p=0.04) and absent PVR (p=0.000)
showed better activities of daily living. Age (p=0.22) and sex (p=0.53) did not show a
significant association. Eighteen (11.5%) out of the 129 patients experienced a well
satisfied composite scores change whereas 27 (17.3%) experienced no improvement in
satisfaction. Early intervention for RRD has proven better anatomical outcomes. Therefore,
should pay attention to reduce waiting time for treating RRD.