Is Intralesional Methotrexate an Effective Alternative to Intralesional Triamcinolone in Alopecia Areata? Findings From a Randomized Controlled Trial.

Background: Alopecia areata (AA) is an autoimmune condition resulting in hair loss, sometimes just in small patches but occasionally across larger areas like the entire scalp. For localized AA, treatments often involve injecting corticosteroids, such as triamcinolone acetonide (TrA), directly into the affected areas. Methotrexate (MTX), a drug known for its ability to suppress immune responses, has also been considered as an alternative. However, there has not been much research directly comparing these two treatments.

Methods: This study involved 40 individuals with localized AA. These patients were divided into two groups: one received TrA injections, and the other was given MTX. Both groups were treated once a month for 3 months. We tracked their progress using the Severity of Alopecia Tool (SALT) over 6 months. Their trichoscopic findings, adverse effects, and satisfaction with treatment were also documented.

Results: Cases receiving TrA showed strong improvements, with their SALT scores dropping by an average of 54.36%, which meant significant hair regrowth. In contrast, the MTX group saw their scores worsen by 54.6%, meaning losing more hair. For trichoscopic changes, both groups showed some progress, but only the reduction in black dots in the MTX group was statistically significant. Side effects like mild redness or pigmentation changes were uncommon and similar for both groups. When asked how satisfied they were, patients who received TrA gave a much higher score:7.1 out of 10 compared to 4.9 for MTX.

Discussion: According to our results, TrA outperformed MTX in treating localized AA, both in terms of hair regrowth and patient satisfaction. While MTX may have potential as a therapy, its inconsistent performance in this study suggests it is not ready to be a primary option for localized AA. Future research is needed to explore whether adjusting doses or combining it with other treatments could result in better outcomes.