Clinical Question

Are high-potency topical corticosteroids more effective than low-potency corticosteroids for alopecia areata in children?

Bottom Line

Clobetasol propionate, 0.05%, applied in a thin layer for six weeks on, six weeks off, is a highly effective and safe treatment for alopecia areata in children; hydrocortisone, 1%, is not. (Level of Evidence = 1b)

Synopsis

There are limited randomized controlled trial data regarding treatment of alopecia areata. In this trial, 41 children (age range = two to 16 years) who had at least 10% scalp involvement were randomized to receive a high-potency topical corticosteroid (clobetasol propionate, 0.05%) or a low-potency topical corticosteroid (hydrocortisone, 1%). Patients who used other corticosteroids, immunosuppressants, recent topical therapy, or recent light therapy were excluded. Patients, physicians, and outcome assessors were all masked to the treatment assignment. The cream was applied twice daily in a thin layer to the affected area for two cycles of six weeks on, six weeks off. The primary outcome was the surface area of hair loss as measured by a dermatologist masked to treatment assignment. The median baseline area of hair loss decreased from 72 cm to 3 cm in the high-potency group, and increased slightly from 49 cm to 55 cm in the low-potency group. A total of 85% of patients in the high-potency group showed at least a 50% reduction in surface area compared with 33% in the low-potency group (P < .001; number needed to treat = 2). In addition, there was a 96.5% reduction in scalp surface area affected by hair loss in the high-potency corticosteroid group compared with only 4.6% in the low-potency corticosteroid group (P = .002). The primary adverse effect was skin atrophy in one patient with extensive disease, which resolved during the off cycle. Urinary cortisol levels revealed no evidence of adrenal suppression.

Study design: Randomized controlled trial (double-blinded)

Funding source: Government

Allocation: Concealed

Setting: Outpatient (specialty)

Reference: LenanePMacarthurCParkinPCet alClobetasol propionate, 0.05%, vs hydrocortisone, 1%, for alopecia areata in children: a randomized clinical trial. JAMA Dermatol.2014; 150( 1): 47– 50.