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

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.