Dermatologists Prefer Topical Corticosteroids for Children with Alopecia

Pediatric alopecia areata (PAA) dermatologists prefer class 1 and 2 topical corticosteroids as first-line treatment therapy, a new survey analysis finds. The survey findings were published in the December issue of the Journal of the American Academy of Dermatology.

Nanette Silverberg, M.D.

Researchers, led by Nanette Silverberg, M.D., chief, pediatric dermatology, Department of Dermatology, Mount Sinai Health Systems, Icahn School of Medicine at Mount Sinai, analyzed 53 responses from dermatologists who treat pediatric alopecia areata (PAA). Data were categorized between therapy of choice for children 8 years or younger and therapy of choice for children ages 8 years or older with alopecia areata. The two patient categories were divided based on the extent of scalp involvement (less than 25% or more than 25%), and the providers were categorized as either fellowship trained (FT) or nonfellowship trained (NFT).

Researchers found for children aged 8 years or younger, fellowship trained pediatric dermatologists were most likely to choose class 1 topical corticosteroids as first-line therapy for all patients regardless of scalp involvement. Although nonfellowship trained pediatric dermatologists were also most likely to prescribe class 1 corticosteroids for patients with more than 25% scalp involvement (53.8%), they were most likely to prescribe class 2 topical corticosteroids for patients with less than 25% involvement (42.9%).

For children aged 8 years and older, both fellowship-trained and nonfellowship-trained pediatric dermatologists preferred class 1 topical corticosteroids in patients with less than 25% scalp involvement and those with greater than 25% involvement.

The second-line therapy treatment preferences were not as consistent. Among nonfellowship-trained pediatric dermatologists, intralesional triamcinolone was the most common second-line therapy for children 8 years or younger with less than 25% scalp involvement (46.2%). However, fellowship-trained respondents were most likely to choose oral methotrexate for patients 8 years and younger with more than 25% scalp involvement (38.5%). Nonfellowship-trained respondents leaned toward topical minoxidil 5% solution for patients with more than 25% involvement (53.8%) and intralesional triamcinolone for patients with less than 25% involvement (76.9%).

However, for children 8 years and older with less than 25% involvement, intralesional triamcinolone was the most common second-line therapy among both fellowship-trained and nonfellowship-trained providers. For children 8 years and older with more than 25% scalp involvement, oral methotrexate and minoxidil 5% solution were the most preferred second-line therapy among fellowship-trained and nonfellowship-trained providers, respectively.

Study limitations included selection bias, potentially hindering the measure of association and may not have accurately reflected the targeted population. The sample size was also skewed towards junior respondents’ perception. The length of the therapeutic trial, types of counseling practices, and any long-term monitoring was neglected within the study.

The survey data is significant to general practitioners treating alopecia areata by demonstrating the consistent practice patterns depicted. Additional drug safety and efficacy studies with topical and oral Janus kinase inhibitors for patients with pediatric alopecia areata are necessary to continue successful research.

Reference

Bitterman D, Bitterman D, Sink J, et al. Survey of pediatric dermatologist views on treatment for alopecia areata. JAAD Int. 2023;13:71-73. doi:10.1016/j.jdin.2023.06.016

This story first appeared on American Journal of Managed Care