Alteration of serum and tissue tumor necrosis factor alpha levels: A possible mechanism of action of oral pulse steroids in the treatment of alopecia areata.

Abstract

Alopecia areata (AA) is a multifactorial disease in which tumor necrosis factor alpha (TNF-α) plays an important role. To study the effect of oral pulse steroids on both serum and tissue levels of TNF-α in AA patients. Skin biopsies and serum samples were collected from 20 patients with patchy AA before and after treatment (oral prednisolone for two consecutive days every week for 3months) for determination of the levels of TNF-α levels using ELISA technique. Both serum and tissue levels of TNF-α in AA patients were significantly higher than in controls before (P<0.001) as well as after treatment (P=0.0169 and P=0.3051), respectively. The duration of disease negatively correlated with tissue TNF-α before treatment (P<0.0001). Serum and tissue levels of TNF-α dropped significantly after treatment (P<0.0001). The percentage of reduction of both tissue and serum TNF-α levels correlated positively with the percentage of clinical improvement (r=0.682, P=0.0009; r=0.567, P=0.009, respectively). TNF-α plays an important role in the evolution of AA lesions, and alteration in both serum and tissue levels of TNF-α could be considered one of the important mechanisms of action of systemic oral pulse steroids in the treatment of AA.