When JAK Inhibitors Are Off The Table: Durable Remission Of Severe Alopecia Areata With Dexamethasone Oral Mini-Pulse And A Focused Review

In cases where JAK inhibitors are not an option for treating alopecia areata (AA), dexamethasone oral mini-pulse (OMP) therapy offers a viable alternative. A case study of a 52-year-old woman with systemic lupus erythematosus and a renal transplant showed significant improvement in her AA, with her SALT score dropping from 90 to 21 after four months of OMP therapy. This improvement was sustained at 12 months without maintenance therapy or adverse effects. A review of 14 clinical studies supports OMP's efficacy, with 89% of patients showing improvement and a 71% median SALT reduction by week 24. While relapse occurs in about 60% of responders after stopping treatment, OMP remains a safe and effective outpatient option for those ineligible for JAK inhibitors.