Abstract

Alopecia areata (AA) is an autoimmune condition characterized by non-scarring hair loss. The condition can significantly impact quality of life and self-esteem. Despite its prevalence, there is no universally accepted treatment protocol, and numerous therapeutic approaches have been explored. Among these, combination therapies have gained attention for potentially enhancing efficacy and minimizing adverse effects. A systematic review was conducted focusing on the combination treatment of dexamethasone minipulse (DMP) and methotrexate (MTX) in the management of AA, evaluating its effectiveness and associated treatment-related adverse effects. PubMed, Cochrane Library, and Google Scholar were searched for studies published up to July 2023 using keywords such as "Alopecia areata," "dexamethasone minipulse," "methotrexate," "combination therapy," "effectiveness," and "adverse effects." Inclusion criteria were randomized controlled trials (RCTs), observational studies, and cohort studies that evaluated the combination treatment of DMP and MTX in AA. Exclusion criteria included case reports, reviews, and studies lacking sufficient data on efficacy or adverse effects. Multiple RCTs demonstrated that the combination of DMP and MTX significantly improves hair regrowth in AA patients compared to monotherapy. One RCT reported a 60% improvement in the combination group versus 35% in the MTX alone group.Observational Studies: A large cohort study showed a response rate of 70% in patients receiving combination therapy, with significant improvement noted within 12 weeks of treatment initiation. Studies with follow-up periods exceeding 12 months indicated sustained hair regrowth in patients treated with the combination therapy, with lower relapse rates compared to monotherapy. Patients treated with DMP and MTX showed a significant reduction in SALT scores, indicating a greater percentage of hair regrowth. One study reported a mean SALT score reduction from 60 to 20 after 24 weeks of combination therapy. Increased blood glucose levels and weight gain were common, though less pronounced than with continuous high-dose corticosteroid therapy. Mood swings, insomnia, and anxiety were reported in a minority of patients, generally resolving with dose adjustment or discontinuation. Nausea, vomiting, and oral ulcers were frequent but manageable with folic acid supplementation and dose adjustments. Mild leukopenia and anemia were observed in some patients, necessitating regular blood monitoring. Elevated liver enzymes were noted in a small percentage of patients, which resolved with temporary discontinuation or dose reduction of MTX. The combination therapy's immunosuppressive effects increased susceptibility to infections, though no severe infections were reported in the reviewed studies. The potential for cumulative toxicity necessitates careful patient selection and regular monitoring, particularly in long-term treatment regimens. The combination of dexamethasone minipulse and methotrexate appears to be an effective treatment for alopecia areata, offering significant improvement in hair regrowth compared to monotherapy. The dual mechanism—DMP's anti-inflammatory action and MTX's immunomodulatory effect—may provide a synergistic benefit, addressing different aspects of the autoimmune pathophysiology of AA. However, the combination therapy is not without risks. The incidence of adverse effects, although generally manageable, underscores the need for close monitoring and individualized treatment plans. Regular follow-ups and appropriate dose adjustments are critical to minimizing adverse effects while maximizing therapeutic outcomes. Combination therapy with dexamethasone minipulse and methotrexate is a promising approach for treating alopecia areata, demonstrating enhanced efficacy in hair regrowth and acceptable safety profiles. Further large-scale, long-term studies are warranted to establish standardized protocols and optimize patient outcomes.68.6%) and extended activities of daily living (n=125, 80.1%) were affected. Patients with Early presentation (p=0.000), early intervention (p=0.013), macular-on (p=0.04) and absent PVR (p=0.000) showed better activities of daily living. Age (p=0.22) and sex (p=0.53) did not show a significant association. Eighteen (11.5%) out of the 129 patients experienced a well satisfied composite scores change whereas 27 (17.3%) experienced no improvement in satisfaction. Early intervention for RRD has proven better anatomical outcomes. Therefore, should pay attention to reduce waiting time for treating RRD.