Related Experiment Video
Updated: Feb 10, 2026
Author Spotlight: Alleviating Nausea and Vomiting in Pregnancy with Safe and Effective Auricular Acupuncture
Published on: August 4, 2023
Is methotrexate an effective and safe treatment for maintaining hair regrowth in people with alopecia totalis? A
R Browne1, L Stewart2, H C Williams1
1Department of Dermatology, Queen's Medical Centre, Nottingham, U.K.
Clinical Question/Scenario:
Is methotrexate (MTX) an effective and safe treatment for maintaining hair regrowth in people with alopecia totalis?
Background:
Alopecia areata (AA) is a common disorder causing nonscarring hair loss with an estimated lifetime prevalence of approximately 2%. Treatment of extensive AA is challenging. The aim of this Critically Appraised Topic was to assess the current evidence regarding use of MTX for inducing and maintaining hair growth in patients with alopecia totalis.
Methods:
We critically appraised the literature identified from searching PubMed, Ovid MEDLINE, Ovid Embase and Cochrane Central (October 2017), using the search terms ("alopecia areata" OR "alopecia totalis" OR "alopecia universalis") AND (methotrexate).
Results/Identified Evidence:
Two prospective studies and 11 retrospective case series were included, comprising 226 patients with alopecia varying from 30% hair loss to alopecia universalis at baseline. MTX was usually given with systemic corticosteroids for induction of hair regrowth rather than regrowth maintenance. Regrowth, defined as anything from 50% to complete regrowth, was reported in 20-90% of patients. Relapse occurred in 20-80%, with variable regrowth on retreatment. Most series were small, with limited methodological detail and follow-up data. Adverse effects ranged from 7% to 60%.
Discussion And Recommendation For Clinical Case:
We found insufficient evidence to conclude whether MTX is useful for maintaining regrowth in extensive AA. We found some evidence to suggest that hair regrowth may be induced by MTX when used in combination with systemic corticosteroids, but it was difficult to attribute responses to any one treatment or spontaneous regrowth. Included case series were at a high risk of bias. Randomized controlled trials are needed to evaluate whether MTX alone, or in combination with corticosteroids, vs. placebo is useful for inducing and/or maintaining remission of hair regrowth. In the meantime, MTX may occasionally be considered in people with severe disease that significantly impacts on their quality of life.
Related Concept Videos
02:57The Sense of Self: Reflected Self-Appraisal and Social Comparison
01:22Hair Cells
01:20Lazarus's Cognitive Appraisal Theory
Primary Appraisal:...
03:26Framing Effects
01:16Accessory Structures of the Skin: Hair and Hair Follicles
Hair is a keratinous filament growing out of the epidermis. It is primarily made of dead, keratinized cells. Hair strands originate at the epidermal penetration called the hair follicle. The hair shaft is the part...
01:16Critical Region, Critical Values and Significance Level
In hypothesis testing, a sample statistic is converted to a test statistic using z, t, or chi-square distribution. A critical region is an area under the curve in probability distributions demarcated by the critical value. When the test statistic falls in this region, it suggests that the null hypothesis must be rejected. As this region contains all those values of the...