What are corticosteroids?
Corticosteroids or steroids, for short, are a class of prescription and over-the-counter medications that are used for conditions where the immune system is overactive. Steroids work by decreasing the release of several pro-inflammatory mediators such as prostaglandin and leukotrienes.
Why are corticosteroids part of my treatment plan?
Topical steroids are first-line therapy for patchy limited hair loss with alopecia areata. Your genetic profile indicated that your GR-alpha gene is normal. This gene encodes for the steroid receptor, and abnormalities in the gene make steroid therapy less effective. In these cases, we may have to use higher doses which increase the risk of side effects.
Are topical corticosteroids effective for alopecia areata (AA)?
Topical therapy with high potency corticosteroids have shown efficacy in clinical trials for alopecia areata. A trial of 70 patients with desoximetasone had 58% regrow their hair entirely after 12 weeks.1 Another 12-week trial compared betamethasone vs. triamcinolone injections vs. tacrolimus and found that more than 75% of people using betamethasone (the steroid) regrow their hair.2
Are there any adverse effects to using topical corticosteroids?
Adverse reactions can occur when using steroids and are more likely with longer durations and higher potency formulations. Adverse effects include local skin atrophy, hypo or hyperpigmentation, acne, redness, burning, stretch marks, telangiectasias, swelling, itching, pain, skin infections, and rarely adrenal suppression.3
How long is the treatment course for Alopecia areata?
Treatment for AA needs to be individualized based upon the response to therapy. In general, therapy is tapered within three to six months of starting therapy. If there is no response to initial therapy within three months, another agent will need to be initiated.
- Charuwichitratana S, Wattanakrai P, Tanrattanakorn S. Randomized double-blind placebo-controlled trial in the treatment of alopecia areata with 0.25% desoximetasone cream. Arch Dermatol. 2000;136(10):1276-1277. doi:10.1001/archderm.136.10.1276
- Kuldeep C, Singhal H, Khare AK, Mittal A, Gupta LK, Garg A. Randomized comparison of topical betamethasone valerate foam, intralesional triamcinolone acetonide and tacrolimus ointment in management of localized alopecia areata. Int J Trichology. 2011;3(1):20-24. doi:10.4103/0974-7753.82123
- Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006;54(1):1-18. doi:10.1016/j.jaad.2005.01.010