Intralesional Methotrexate versus Triamcinolone Acetonide for Localized Alopecia Areata (AA) Treatment

Document Type : Original Article

Abstract

Background: Alopecia areata (AA) is a common, immune-mediated cause of non-cicatricial hair loss with unpredictable course and limited durable treatment options. Intralesional triamcinolone acetonide (TrA) remains the standard therapy for localized disease, while methotrexate (MTX) has emerged as a potential alternative due to its immunomodulatory effects. Objective: To compare the efficacy and safety of intralesional MTX versus TrA in the treatment of localized AA in adults.
Patients and Methods: In this randomized phase II clinical trial, 50 adults (>18 years) with patchy AA involving <50% of the scalp were equally allocated to intralesional MTX (25 mg/mL; 0.1–0.2 mL/session) or TrA (10 mg/mL; ≤2 mL/session) every 3 weeks for up to four sessions. Severity of Alopecia Tool (SALT) scores, patient satisfaction, and adverse events were assessed at baseline, 3 months, and 6 months. Results: Baseline characteristics were comparable between groups. Mean SALT scores improved significantly in both MTX (2.72 ± 1.49 to 0.48 ± 1.42) and TrA (2.88 ± 1.45 to 0.60 ± 1.41) groups by 6 months (both p < /em> < 0.001), with no significant intergroup difference (p < /em> = 0.389). High satisfaction was reported in 64.0% (MTX) and 52.0% (TrA) patients. Adverse events differed: hyperpigmentation occurred in 32.0% of MTX patients, while hypopigmentation and atrophy occurred only in the TrA group (8.0% each) (p < /em> = 0.018). The mean number of sessions was similar (MTX: 3.60; TrA: 3.68).
Conclusions: Intralesional MTX and TrA offer comparable efficacy in localized AA, but their distinct safety profiles—hyperpigmentation with MTX and atrophy with TrA—should guide individualized treatment selection.

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The Egyptian Journal of Hospital Medicine
Volume 100, Issue 1
July 2025
Pages 3711-3716

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