Recalcitrant Widespread Alopecia Areata in a Child Treated Successfully with Oral Methylprednisolone Pulse Therapy

Alopecia areata is a common condition with patchy non scarring hair loss. We report a case of an 11 year old male child with localized patch of hair loss on the frontoparietal region of the scalp since one year. It was a widespread extensive patch of hair loss covering more than 40% of the scalp. On hair shaft microscopy, numerous exclamation mark hairs were present. The patient was put on topical tacrolimus and topical corticosteroids but no response was seen. Since the child was recalcitrant to treatment, methylprednisolone 500 mg/day on three consecutive days in a month was given. After six months 80% regrowth was seen over the affected area of the scalp.