Extensive Alopecia Areata: Not Necessarily Recalcitrant to Therapy

Between 2008 and 2010, a study involving 15 patients with extensive, treatment-resistant alopecia areata tested a combination therapy of oral betamethasone mini-pulse, topical minoxidil, and short contact anthralin. The patients, aged 7 to 45, included various forms of alopecia, such as alopecia universalis (AU), alopecia totalis (AT), ophiasis, and those with significant scalp involvement. The effectiveness of the treatment was measured using the SALT score, aiming for a cosmetic response that would eliminate the need for a wig. Results indicated that 4 out of 8 patients with AU/AT achieved a cosmetic response within 3 to 6 months, with 1 additional patient showing partial response. All patients with ophiasis and those with more than 50% scalp involvement attained cosmetic response at 6 months. Overall, 80% of responders maintained their response for over 12 months without systemic steroids. Two AU patients had a mild relapse treated with intralesional steroids, and side effects were mild and reversible. The study concluded that the combination therapy was effective and safe for those with extensive, long-standing alopecia areata.