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.