Efficacy and Tolerability of Methotrexate for Treating Severe Pediatric Alopecia Areata


eMediNexus    16 December 2022

Alopecia areata (AA) is a chronic, autoimmune condition that affects hair follicles. In the pediatric population, AA is associated with a poorer prognosis and has limited treatment options compared to adults. Literature supports its treatment with oral methotrexate (MTX) in adults, but there is a lack of data on its use in the pediatric population. 


The present study investigated the efficacy and tolerability of MTX in severe pediatric AA. It performed a retrospective review on pediatric patients with severe AA who were treated with MTX. 


The study observed:


  • Enrollment of 13 patients (6 boys and 7 girls) aged between 4 and 16 years at the initiation of MTX (mean age of 8.8 years).
  • Interval of 8 months to 9 years (mean duration of 3.3 years) from diagnosis of AA to commencement of MTX.
  • Once weekly administration of oral MTX with a mean maximal dose of 0.4 mg/kg/dose.
  • Among 12 assessable patients, 5 showed treatment success as they had more than 50% regrowth, while the other 7 were treatment failures.
  • No serious side effects.


This study shows a variable efficacy of MTX for treating pediatric AA with overall good tolerability. MTX can be a potential candidate for treating severe refractory AA in children.


Source: Albela H, Begum S, Wee AL, et al. Efficacy and tolerability of methotrexate in the treatment of severe paediatric alopecia areata. Skin Appendage Disord. 2022;8:206-10. 

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