# Efficacy and Safety of Oral Betamethasone Mini-Pulses in Moderate to Severe Alopecia Areata

## TL;DR

This study shows that oral betamethasone mini-pulses are effective and safe for treating moderate to severe alopecia areata, with significant hair regrowth and minimal side effects.

## Contribution

The study introduces oral betamethasone mini-pulses as a novel treatment option for moderate to severe alopecia areata in resource-limited settings.

## Key findings

- 62.5% of patients achieved ≥50% hair regrowth, with 25% experiencing complete regrowth.
- Adverse events were mild and transitory, occurring in 20% of cases.
- Patchy AA and lower baseline SALT scores were significantly associated with better treatment response.

## Abstract

Introduction

Alopecia areata (AA) is an acquired autoimmune disorder affecting hair follicles, responsible for non-scarring alopecia with an unpredictable clinical course. Systemic corticosteroids are commonly prescribed in acute or rapidly progressing forms, but their long-term use is limited by potential adverse effects. Intermittent oral corticosteroid regimens, referred to as mini-pulses, have emerged as a promising alternative.

Objectives

This study aims to assess the efficacy, safety, and sustainability of the response to oral betamethasone mini-pulses in patients with moderate to severe or refractory AA and to explore clinical and trichoscopic predictors of treatment response.

Materials and methods

We conducted a retrospective cohort study including 40 patients treated for AA at Ibn Sina University Hospital, Morocco, from 2022 to 2025. All patients received oral betamethasone mini-pulses at fixed doses (2 mg for children, 4 mg for adults), administered two consecutive days per week for at least three months, with treatment duration adjusted based on clinical response. Clinical, dermoscopic, and quality of life parameters were assessed using standardized tools, including the Severity of Alopecia Tool (SALT), the Alopecia Areata Scale (AAS), Eyebrow and Eyelash Assessment Scales (EBA/ELA), and the Dermatology Life Quality Index (DLQI). Predictors of treatment response and relapse were analyzed statistically.

Results

A ≥50% hair regrowth (SALT-50) was achieved in 62.5% of patients, including complete regrowth in 25%. Dermoscopic activity markers and DLQI scores also improved significantly after treatment. Adverse events occurred in 20% of cases; all were mild and transitory. Relapses were observed in 15% of patients, mostly partial. Better responses were significantly associated with patchy AA and lower baseline SALT scores. In contrast, poor response correlated with atopic diathesis, including asthma and allergic rhinitis, as well as rapidly progressive forms and higher initial SALT scores. Relapse was associated with autoimmune thyroiditis and vitamin D deficiency.

Conclusion

Oral betamethasone mini-pulse therapy represents an effective and well-tolerated treatment option for moderate to severe or refractory AA. It is particularly relevant in resource-limited settings where access to advanced therapies such as JAK inhibitors remains restricted. Larger, long-term studies are needed to validate these findings, refine treatment duration, and identify ideal responders.