What are the next steps for managing hair loss and facial eczema after completing a prednisone (corticosteroid) course for Polymyalgia Rheumatica (PMR) treatment?

Managing Hair Loss and Facial Eczema After Prednisone Treatment for PMR

For hair loss and facial eczema following prednisone treatment for Polymyalgia Rheumatica (PMR), the recommended approach is to address these as steroid-related side effects through topical treatments for the eczema and reassurance about the typically temporary nature of hair loss, while ensuring proper tapering of prednisone over 1-2 years to prevent relapse of the underlying PMR. 1

Understanding the Side Effects

Hair loss and facial eczema are known side effects of glucocorticoid therapy used in PMR treatment. These side effects occur as part of the spectrum of adverse reactions to prednisone, which should be monitored throughout treatment.

Management of Facial Eczema

1. Topical treatments:

   • Mild-to-moderate potency topical corticosteroids for facial eczema
   • Non-steroidal alternatives such as tacrolimus or pimecrolimus for facial areas
   • Moisturizers to maintain skin barrier function

2. Avoid potential triggers:

   • Harsh soaps and cleansers
   • Extreme temperatures
   • Known allergens

Management of Hair Loss

1. Assessment:

   • Determine if hair loss is diffuse (typical of medication-induced) or patchy
   • Evaluate timing in relation to prednisone treatment and tapering

2. Treatment approach:

   • Reassurance that hair loss is typically temporary and will improve after prednisone is tapered or discontinued
   • Gentle hair care practices
   • Nutritional support including adequate protein intake

Continuing PMR Management

While addressing these side effects, it's crucial to maintain appropriate management of the underlying PMR:

1. Proper prednisone tapering:

   • Continue tapering prednisone according to guidelines (over 1-2 years) 1
   • Taper to 10 mg/day within 4-8 weeks of starting treatment
   • Once remission is achieved, taper by 1 mg every 4 weeks or use alternate day schedules 1
   • Avoid rapid tapering which may trigger PMR relapse

2. Consider steroid-sparing agents:

   • Methotrexate (7.5-10 mg/week orally) may be considered if continued steroid-related side effects are problematic 1
   • Methotrexate has demonstrated effectiveness as a steroid-sparing agent in PMR 1

3. Regular monitoring:

   • Follow-up visits every 4-8 weeks in the first year, every 8-12 weeks in the second year 2, 1
   • Monitor for disease activity, additional steroid-related side effects, and comorbidities

Important Considerations

• Specialist referral: Consider dermatology consultation if eczema is severe or unresponsive to initial management
• Patient education: Explain that these side effects are known complications of prednisone therapy and typically improve with dose reduction
• Individualized approach: The management plan should be tailored based on severity of side effects and PMR disease activity 2

Pitfalls to Avoid

• Don't stop prednisone abruptly: This can lead to PMR relapse and adrenal insufficiency
• Don't overlook other causes: While these symptoms are likely steroid-related, consider other potential causes if symptoms are severe or atypical
• Don't neglect nutritional status: Ensure adequate vitamin D, calcium, and protein intake which may help with both skin and hair health
• Don't miss follow-up appointments: Regular monitoring is essential to assess both side effects and disease activity 2, 1

Remember that while addressing these side effects, maintaining control of the underlying PMR remains the priority to prevent complications of untreated or undertreated disease.