Alopecia universalis: Failure of dexamethasone pulse therapy

C Balachandran, Suraj V Davis

 Department of Skin and STD, Kasturba Medical College and Hospital, Manipal - 576119, India

Correspondence Address:
C Balachandran
Department of Skin and STD, Kasturba Medical College and Hospital, Manipal - 576119
India

To the Editor

An 18-year-old female was having alopecia universalis for the last five years. Initially she used to get partial regrowth of hair with varying dose of oral steroids. Patient never had complete regrowth of hair. There were no systemic complaints. Her routine blood reports, liver function tests and renal function tests were within normal limits. Injection triamcinolone 40mg /ml intramuscularly was tried once a month for six months without any significant regrowth of hair. Oral prednisolone 40mg daily for 2 months also failed to show any improvement. Later we tried injection dexamethasone 100mg intravenously in 5% dextrose for three consecutive days in a month. Patient did not show any regrowth of hair even after six monthly pulses. There were no side effects to the treatment.

Various treatment modalities like topical sensitizers such as squaric acid dibutylester, diphencyprone, dinitrochlorobenzene (DNCB), minoxidil, PUVA therapy and corticosteroids are tried in the treatment of extensive alopecia areata with varied results.[1] Sharma has found fairly good results with 300mg and 1000mg of oral monthly pulses of prednisolone in alopecia totalis and universalis cases.[1] Pasricha has used dexamethasone pulse therapy and betamethasone oral minipulse (OMP) with good clinical response in alopecia totalis/universalis.[2] Though oral steroids are useful in early stages of alopecia total is/universal is established cases fail to respond to even high doses of steroids as seen in this case.

1.	Sharma VK. Pulse administration of corticosteroids in the treatment of alopecia areata. Int J Dermatol 1996; 35 : 133-136. [Google Scholar]
2.	Pasricha JS, Kumrah L. Alopecia totalis treated with oral mini pulse (OMP) therapy with betamethasone. Indian J Dermatol Venereol Leprol 1996; 62: 106-109. [Google Scholar]