Development of a scoring system for the prediction of the outcome of intravenous corticosteroid pulse therapy in rapidly-progressive alopecia areata

Intravenous corticosteroid pulse therapy (pulse therapy) has been reported to be effective for rapidly-progressive alopecia areata (RPAA). However, the outcome can hardly be predicted at an early time point of the course. In this study, we attempted to establish a scoring system for the prediction of the prognosis by retrospectively analyzing clinicopathological and immunological characteristics of RPAA patients treated by pulse therapy. Twenty-two cases (10 females and 12 males, average age 35.6) were administered 500mg/day of intraveneous methylprednisolone for 3 consecutive days. The efficacy was quantitatively assessed at 6-month post-treatment by digital image analysis based on the recovery from the worst clinical manifestation. The analysis detected positive correlations between the extent of recovery and female gender in those without atopic background (p=0.024) and the absence of atopic background within female subjects (p=0.025). IgG suppression level at 6-weeks post-treatment and the severity of perifollicular cell infiltration tended to be greater in good responders. A prediction score system adopting above-mentioned factors has been developed, which successfully yielded score indexes correlated to recovery rates (r=0.51). Flowcytometric analysis detected post-treatment increase in induced regulatory T cells (iTregs) in several cases. Intriguingly, when the scores reflecting the increase in iTregs was integrated to the formula, the correlation coefficiency was further improved (r=0.63). Further improvement would be necessary, these findings suggested the possibility of developing a scoring system enabling early prediction of treatment outcome of pulse therapy in PRAA, which provides a valuable tool for the management of this frustrating condition.