Combination Treatment with Methotrexate for Severe Alopecia Areata

Alopecia areata (AA) is an autoimmune disorder that is mediated by CD8 T-cells. It presents as nonscarring round patches of hair loss that may become diffuse. It has bimodal incidence, but rarely presents in young adults. In the Philippines, AA prevalence is about 1.8% for both genders. To the best of our knowledge, there are no other publications in the Philippines documenting the successful management of severe diffuse AA with combination corticosteroids and methotrexate while addressing developed side effects. Beyond demonstrating efficacy of combination treatment, it is our interest to highlight the relevance of traditional therapies in the era of newer treatments. This is a case of a 20-year-old female with 2 months of progressive hair loss patches over the scalp. Dermoscopy and biopsy confirmed a diagnosis of diffuse AA. Treatment included a combination of corticosteroids, methotrexate, and supplementation. Significant hair regrowth from Severity of Alopecia Tool score of 92% to 0.1% was observed after 6 months of therapy. While newer therapies such as Janus kinase inhibitors offer promise, the affordability and effectiveness of traditional treatments remain essential, particularly in regions with limited access to advanced therapies. The successful management of severe diffuse AA with combination corticosteroids and methotrexate underscores the importance of tailored treatment approaches. This case highlights the need for continued research into optimal treatment strategies for AA, ensuring that patients receive safe, affordable, and effective care tailored to their individual needs.