Large doses of glucocorticoid in the treatment of alopecia areata.

Severe extensive alopecia areata (totalis) was treated with prednisolone as a single 2 g dose i.v. (22 patients) or 0.5 g daily for 5 days orally (13 patients). Four of the patients responded well, 12 had a poor response and 19 had no response. There was a relapse in some at about 6 months, which could be arrested by a further single i.v. dose, but the risks of this form of therapy are unclear and it cannot be recommended for general use. The clinical response to a single dose of corticosteroid implies, however, that there may be a 'switch' mechanism in certain auto-immune diseases, with an all-or-none response.