I was diagnosed with Alopecia and most of my hair (75%) has nearly gone.

I have low iron (and took for a while iron tabs) but this did nothing for my hair.

My dermatologist has given me Prednisolone tablets (2 per day) for 2 months (decreasing by 1/2 tab each fortnight).

I am not one for tablets especially these that are so potent.

I am scared to take them due to the possible repercussions they could have on me.

If a crystal ball could catergorically tell me that I would regain my hair by taking these tablets…then I would….but no-one can really do that.

What I am concerned about is that the side-effects making me feel and look even more worse than what I am dealing with now with the Alopecia.

What I wanted to ask was, if I were to start taking the tablets, and I felt that the adverse reactions were making me feel and look worse, could I decrease dosage straight away with view of ceasing within several days or so?

I know that ceasing the tabs straight away is not good and can cause huge probs.

My dermotologist just says take them and does not factor my other concerns even though I have discussed them with her. To change dermotologists means a 6 month wait and by then all my hair would have gone.

Do you have any info that could help me in my decision or perhaps other remedies?

Doctor Joshua’s Answer:

Alopecia areata can usually be diagnosed with minimal testing. Other conditions causing similar symptoms need to be ruled out, including telogen effluvium (TE) and fungal infection.

TE usually occurs after a serious illness, infection, pregnancy, menopause, allergic reaction and so on, and usually resolves spontaneously within about 6 months, in contrast to alopecia areata which may result in extensive hair loss over time.

Although in most cases, the diagnosis of alopecia can be made clinically, some lab studies and examinations to rule out underlying more serious causes sometimes need to be done.

Lab studies include thyroid (TSH), CBC, iron, and ferritin.

These examinations may or may not be done depending on the judgment of the physician. A consultation with a dermatologist should be done.

Scalp biopsy is sometimes done.

You are correct that low ferritin has been reported to be associated with alopecia in women. Here’s the reference:
[i]Kantor et al (2003): Decreased serum ferritin is associated with alopecia in women. J Invest Dermatol, Nov; 121(5): 985-8[/i]

It’s understandable that you are frustrated with prednisolon therapy. There is no guarantee that steroids will help; side effects are usually guaranteed. The doctor should discuss fully the realistic expectations of the treatment, and its potentially serious side effects.

According to a study published in Dermatology, high-dose pulse methylprednisolone treatment may be an effective and well tolerated treatment in some cases. Reference:
High-Dose Pulse Corticosteroid Therapy in the Treatment of Severe Alopecia areata
Simone Seiter et al. Dermatology 2001;202:230-234

However, as the evidence for neither continous nor pulse corticosteroid treatment is not convincing, the treatment guidelines for alopecia areata do not recommend either of these treatments. Here’s the link:
http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=6618&nbr=4162

Local (intralesional) corticosteroid therapy can be used. Contact immunotherapy also has been used with success.

Systemic (oral or intravenous), continuous prednisone treatment is not recommended, as it has potentially serious side effects.

Please do not discontinue any medication prescribed by your doctor. I do not have specific knowledge of your case in particular, and cannot make any treatment suggestions. Please discuss these points with your own doctor.

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