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We found no systematic reviews or RCTs. Numerous case series have been reported but these are not directly comparable because of different patient selection, dose scheduling and duration of therapy. Winter et a/.42 treated 18 patients with prednisolone on alternate days at doses adjusted according to the clinical response (usually 2-4 times the daily adrenal replacement dose, and up to 80-120 mg on alternate days in unresponsive patients). A progressively increasing dose of prednisolone was required to maintain cosmetically acceptable hair growth and most patients experienced a rapid hair loss after discontinuation of prednisolone therapy.42 Oral steroids used in combination with topical and intralesional steroids have shown benefit in non-randomised trials.43 The use of topical and intralesional steroids allowed for more rapid lowering of oral doses and thus minimisation of side-effects. Seven of 15 patients treated with oral steroids showed regrowth of most or all of their hair, with an average remission of 32 months.43 Pulse therapy was used in 32 patients with widespread alopecia areata.44 Doses of 300 mg prednisolone at 4-week intervals for a minimum of four doses were given to 27 patients. Least success was noted in women and patients with alopecia areata for more than 2 years. Complete or cosmetically acceptable hair regrowth was seen in 14 patients, with response evident on average after 2-4 months and cosmetically acceptable at 4 months. Of eight patients who received pulses of 1000 mg, three had cosmetically acceptable hair growth at 6-9 months.44

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