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<p>Intralesional triamcinolone acetonide (TA) is the most commonly used treatment for patchy alopecia areata (AA) in varying concentrations. However, the optimal concentration remains debatable in view of side effects at higher dosages and lower efficacy at lower concentrations. This study compares the therapeutic efficacy and safety of two intra-lesional TA concentrations in the scalp’s patchy alopecia areata. Fifty-nine consecutive patients were randomized into two groups, A (<i>n</i> = 30) and B (<i>n</i> = 29), who received intra-lesional injections of TA 5&#xa0;mg/ml and 10&#xa0;mg/ml, respectively, every 3 weeks for 4 sessions or until complete hair re-growth whichever was earlier. Both clinical and dermoscopic assessment was done at each visit for a total duration of 12 weeks. A regrowth scale (RGS) score of 4 (indicating &gt; 75% hair regrowth) was achieved in more patients in group B in comparison to group A at 6 weeks and 9 weeks (<i>p</i> &lt; 0.0001). The mean number of sessions required to achieve RGS 4 was significantly lower in group B (2.47 ± 0.61) than in group A (3.83 ± 0.38) (<i>p</i> &lt; 0.0001). A decreasing trend of dystrophic grading scores was observed in both groups. However, both groups were comparable in terms of efficacy and side effects at 12 weeks. Therefore, it may be better to individually discuss the “step-down” or “step-up” approach of intralesional triamcinolone acetonide in patchy alopecia areata of the scalp with every patient based on their will of a slightly faster response on the expense of a slightly higher risk of local side effects.</p>

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Step-down approach to concentration of intra-lesional triamcinolone acetonide in treatment of scalp patchy alopecia areata: insights from an open-label randomized trial

  • 期刊论文

  • 发表日期：

    2025年11月17日

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  • Bhavnish Bansal,
  • Shivani Bansal,
  • Sushama Sushama,
  • Kavita Poonia

摘要

Intralesional triamcinolone acetonide (TA) is the most commonly used treatment for patchy alopecia areata (AA) in varying concentrations. However, the optimal concentration remains debatable in view of side effects at higher dosages and lower efficacy at lower concentrations. This study compares the therapeutic efficacy and safety of two intra-lesional TA concentrations in the scalp’s patchy alopecia areata. Fifty-nine consecutive patients were randomized into two groups, A (n = 30) and B (n = 29), who received intra-lesional injections of TA 5 mg/ml and 10 mg/ml, respectively, every 3 weeks for 4 sessions or until complete hair re-growth whichever was earlier. Both clinical and dermoscopic assessment was done at each visit for a total duration of 12 weeks. A regrowth scale (RGS) score of 4 (indicating > 75% hair regrowth) was achieved in more patients in group B in comparison to group A at 6 weeks and 9 weeks (p < 0.0001). The mean number of sessions required to achieve RGS 4 was significantly lower in group B (2.47 ± 0.61) than in group A (3.83 ± 0.38) (p < 0.0001). A decreasing trend of dystrophic grading scores was observed in both groups. However, both groups were comparable in terms of efficacy and side effects at 12 weeks. Therefore, it may be better to individually discuss the “step-down” or “step-up” approach of intralesional triamcinolone acetonide in patchy alopecia areata of the scalp with every patient based on their will of a slightly faster response on the expense of a slightly higher risk of local side effects.