Lalosevic, Jovan (57190969635)Jovan (57190969635)LalosevicGajic-Veljic, Mirjana (24767639800)Mirjana (24767639800)Gajic-VeljicBonaci-Nikolic, Branka (10839652200)Branka (10839652200)Bonaci-NikolicStojkovic Lalosevic, Milica (57218133245)Milica (57218133245)Stojkovic LalosevicNikolic, Milos (56910382000)Milos (56910382000)Nikolic2025-06-122025-06-122019https://doi.org/10.1111/dth.13092https://www.scopus.com/inward/record.uri?eid=2-s2.0-85074099962&doi=10.1111%2fdth.13092&partnerID=40&md5=913aa3cc617caf2bc5c6fac57becd6a9https://remedy.med.bg.ac.rs/handle/123456789/5391There is no universally accepted treatment for severe pediatric alopecia areata (AA). This prospective study comprised 73 patients (aged 1–18 years) with severe AA (>30% of scalp surface area): 37 received 1-day intravenous dexamethasone pulses (1-DP) and 36 received 3-day pulses (3-DP), monthly, for 6–12 months. Also, all patients applied topical clobetasol propionate under plastic wrap occlusion. Patients achieving >50% regrowth were considered good responders (GR). All patients reached short term, while 65/73 were available for the long-term follow-up (mean 33.3 ± 15.3 vs. 27.7 ± 14.3 months, 1-DP and 3-DP, respectively). Relapses during therapy were more frequent in 1-DP group. 3-DP patients were more frequently GR in comparison with 1-DP. 3-DP patients with disease duration <6 months had better outcomes. Patients without Hashimoto thyroiditis (HT) had 9.8-fold higher chance of being GR in comparison with HT patients. The best results were achieved in AA plurifocalis (AAP). No patient had severe short-term side-effects. At the long-term follow-up, 67% of 3-DP patients had stable results. Only 14.2% AAP patients experienced relapses. Patients had no long-term side-effects. 3-DP were more efficacious than 1-DP. Short disease duration and no HT were good prognostic factors. 3-DP protocol is well-tolerated, with beneficial effects and long-lasting results in severe pediatric AA. © 2019 Wiley Periodicals, Inc.alopecia areatachildrenclobetasolpulse corticosteroid therapy