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Methotrexate has been used both as monotherapy and as an adjunct to corticosteroids in the treatment of alopecia areata, but there is only a small amount of definitive evidence and guidelines in this setting.

A recent study aimed to:

1. determine the efficacy and risks associated with methotrexate therapy for alopecia areata,
2. determine the differences in efficacy of combination (methotrexate plus corticosteroids) versus stand-alone (methotrexate) treatment, and
3. determine the relative efficacy of methotrexate in adult versus paediatric populations.

In the systematic review and meta-analysis, methotrexate was found to have reasonable effectiveness in patients with severe alopecia areata, with adults being more responsive to methotrexate treatment than paediatric patients. The study found that combination treatment resulted in a higher complete response rate than methotrexate stand-alone treatment.

However, a large proportion of patients had recurrence in the setting of tapering treatment. Complication rates were acceptable and similar between adult and paediatric patients.

The study concluded that methotrexate is an effective monotherapy or adjunct therapy in combination with corticosteroids in the treatment of severe alopecia areata.

Read more research about alopecia.

Source: Phan, Kevin et al. Methotrexate for alopecia areata: A systematic review and meta-analysis. Journal of the American Academy of Dermatology, Volume 80, Issue 1, 120 – 127.e2

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