Pulse Corticosteroid Therapy for Alopecia Areata: Long-Term Outcome after 10 Years.
圓禿的類固醇脈衝治療:10年的長期結果追蹤

圓禿的治療一般門診還是侷限在外用藥物和病灶內注射兩項,只有某些情況下,
會用到所謂的類固醇脈衝治療:

Pulse corticosteroid therapy 類固醇脈衝治療分為口服和注射兩種,只是
在選擇上的適應症多以嚴重型圓禿為主,或是所謂全頭禿或全身禿.

在最新2012年的這篇追蹤10年的治療結果,似乎結果是相對負向的,
不過以我在臨床上治療的結果而言,何時要用脈衝治療介入也是另一個嚴峻的課題.

讓我們來看看這篇文章的結果又是如何?
 

本次實驗是用回溯性問卷統計的方式,針對60名病患進行追蹤:
1995~2000 60名 短期追蹤
1995~2010 30名 長期追蹤

在30名病患中,10人在脈衝治療後6個月,會有頭髮生長的現象,
再分析反應與嚴重度的關係時:
1. 多發圓禿的病患會有50%有反應,
2. 但對於嚴重的全頭禿或全身禿的患者,治療反應率會降到25%以下,

若近一步針對6個月沒反應的20名病患中,可以看到70%的病患都發展成嚴重型圓禿,
若針對6個月內有反應的10名病患中,可以看到80%的病患最後都很輕微或恢復,

所以在本篇文章仍可以給我們一些治療上的啟發,
若是在病患身體可以接受的狀況,仍應該採用積極的治療,以期患者能有更完全的恢復,
當然同時也可以預期患者之後的變化.

                               2012.9.24 李承鴻 感恩合十

以下為原文摘錄

Background: Few data are available concerning the efficiency of pulse corticosteroids in alopecia areata (AA). Objective: Our purpose was to assess the long-term outcomes of patients treated with methylprednisolone bolus. Methods: This study included 60 patients treated between 1995 and 2000. The short-term outcomes were analyzed in 2000. The long-term assessment of 30 patients was performed in 2010 by phone questionnaire. Results: Significant hair regrowth was observed in 10/30 patients at 6 months after the bolus treatment. Half of the plurifocalis AA patients were responders at 6 months, but less than one quarter of alopecia totalis (AT) and alopecia universalis (AU) patients responded. Long-term outcomes were assessed after a mean duration of 12.3 years; 8/10 initial responders had mild or no disease, and 14/20 initial nonresponders had severe AA. Conclusions: This study confirmed the low efficiency, both short- and long-term, of this treatment for AT and AU