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Shreberk-Hassidim R, Ramot Y, Gilula Z, Zlotogorski A (2016) A systematic review of pulse steroid therapy for alopecia areata

Frequency: one subcutaneous injection each day at a consistent time, titrating up as tolerated over a 12-week cycle

Vuksic T, Zoricic I, Brcic L, Sever M, Klicek R, Radic B, et al

Local (and systemic) estradiol can stimulate lesion production of PGE2, which can activate pain fibers, enhance neuronal invasion of lesions by stimulating production of NGF and other neurotrophins, and promote sprouting of nociceptors that contribute persistent inflammatory pain and inhibit neuronal apoptosis

Additionally, its major advantage of weight loss is now superseded by the use of GLP-1 RAs