Superficial Cryotherapy Versus Intralesional Corticosteroid Injection In Alopecia Areata: A Comparative Clinical And Dermoscopic Study

Background: Alopecia areata (AA) is a common, non-scarring type of hair loss, affecting approximately 2.1% of the population. Many modalities of treatment are recommended like steroid injection, topical Immunotherapy, and several systemic therapies, but none of them can prevent or alter the course of the disease with variable degrees of improvement.
Objective: To evaluate efficacy and safety of superficial cryotherapy versus intralesional corticosteroid injection in the treatment of alopecia areata.  Patients and Methods: Thirty patients aged 14-58 years, with localized multiple patchy alopecia areata (at least two patches), were enrolled in this study. In each patient, one patch was treated by superficial cryotherapy via liquid nitrogen spray. This involved two treatment cycles/sessions, each lasting 3-5 seconds. The other patch was treated with intralesional steroid injection (triamcinolone acetonide 5 mg/ml, 0.1ml /cm². Sessions were repeated every three weeks up to three months. The target lesions were evaluated clinically using SALT score and by 2 blinded dermatologists and dermoscopically at baseline, every session, and the end of the study (one month after the last session). Results: At the end of the study, the clinical response (number of the patients with hair growth > 20%) to superficial cryotherapy was about 83.3% (25 patients out of 30 patients). While in the steroid group the clinical response was about 80% (24 patients out of 30 patients). There was a statistically significant reduction in SALT score and dermoscopic parameters at the end of the study in both groups with no significant difference between them. There was a significant clinico-dermoscopic relation between hair regrowth and dermoscopic findings.
Conclusion: Superficial cryotherapy is an effective and safe therapeutic modality for AA with advantages of simplicity and noninvasiveness.