Oral Methotrexate Monotherapy for Severe Alopecia Areata: A Single Center Retrospective Case Series

J Cutan Med Surg. 2021 Sep;25(5):490-497. doi: 10.1177/1203475421995712. Epub 2021 Mar 9.


Background: Although several therapeutic options have been suggested for alopecia areata (AA), none of them are consistently effective, thus making the management of severe or refractory cases challenging. Several studies have recently reported the usage of methotrexate (MTX) in AA; however, the pure effect of MTX monotherapy remains elusive.

Objective: To evaluate efficacy and safety of oral methotrexate monotherapy for AA.

Methods: We retrospectively reviewed the clinical course of AA patients including pediatric cases treated with MTX monotherapy. Their detailed clinical data including original severity of AA, final treatment outcome, the duration until the maximum response, and side effects, were assessed. Statistical analysis was performed to evaluate if the clinical factors including the duration of current alopecia, age, the presence of body hair loss, and sex were associated with treatment response.

Results: All included patients had severe AA and failed standard therapies. Thirteen out of 15 cases demonstrated improvement during the monotherapy, and all responders demonstrated the maximum response within 1 year. Female patients had significantly better outcomes than male patients. Other factors did not significantly influence on the treatment outcome. None of the patients experienced side effects that were severe enough to terminate the treatment.

Conclusions: Our results support MTX monotherapy as a feasible option for severe AA patients who fail other standard therapies or for whom systemic corticosteroids are contraindicated.

Keywords: alopecia areata; alopecia totalis; alopecia universalis; methotrexate; monotherapy.

MeSH terms

  • Administration, Oral
  • Adolescent
  • Adult
  • Alopecia Areata / drug therapy*
  • Child
  • Dermatologic Agents / administration & dosage*
  • Female
  • Humans
  • Male
  • Methotrexate / administration & dosage*
  • Middle Aged
  • Retrospective Studies
  • Severity of Illness Index
  • Treatment Outcome
  • Young Adult


  • Dermatologic Agents
  • Methotrexate