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Is methotrexate an effective and safe treatment for maintaining hair regrowth in people with alopecia totalis? A critically appraised topic
Author(s) -
Browne R.,
Stewart L.,
Williams H.C.
Publication year - 2018
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.17054
Subject(s) - alopecia areata , hair loss , alopecia universalis , medicine , dermatology , scalp , methotrexate , minoxidil , surgery
Summary Alopecia areata (AA) is a common disorder causing hair loss, which can range from patches, to complete hair loss on the scalp (alopecia totalis), or involving all hair‐bearing sites (alopecia universalis). It can cause anxiety, depression and low self‐esteem. Treatment can be difficult – there are several options but they don't always work and can have unwanted side effects. Hair can in fact regrow without any treatment. The aim of this study was to assess the current evidence regarding use of a drug called methotrexate for getting hair to regrow, and then remain, in people with alopecia. The authors looked at 13 studies comprising 226 patients with alopecia varying from 30% hair loss to alopecia universalis at the start. Methotrexate was usually given with drugs called systemic corticosteroids to start hair regrowth rather than regrowth maintenance. Regrowth, defined as anything from 50% to complete regrowth, was reported in 20‐90% of patients. Relapse (meaning hair re‐grew but then fell out again) occurred in 20‐80%, with variable regrowth on retreatment. Unwanted side effects ranged from 7‐60%. The authors found insufficient evidence to conclude whether methotrexate is useful for maintaining regrowth in extensive alopecia areata. They found some evidence to suggest that hair regrowth may be started by methotrexate when used in combination with systemic corticosteroids, but it was difficult to say which of the treatments this was due to, or if the hair was going to regrow anyway. Further trials are needed.