Dermoscopic evaluation of therapeutic response to intralesional triamcinolone acetonide in the treatment of Alopecia areata

Abstract

Background: Alopecia areata is a common auto-immune condition, characterized by circumscribed, patches of hair loss usually of the scalp. There are various treatment modalities available but no treatment is fully curative or preventive. Also, alopecia areata can have devastating effects on the patient’s quality of life and self-esteem. The aim of this study was to determine dermoscopy findings of alopecia areata that could be used as a clinical indicator of disease and also to evaluate the efficacy of intralesional injection Triamcinolone acetonide in the treatment of alopecia areata.Methods: Seventy patients with alopecia areata, aged between 11 and 56 years were injected with intralesional triamcinolone acetonide at a 4 weeks interval. Treatment response was evaluated using re-growth scale approach. Dermlite DL3 dermoscope was used to assess disease activity, response to treatment and side effects. Using Wilcoxon signed rank test, changes were assessed in the severity of the disease during follow-ups.Results: Baseline mean percentage area of scalp involved was 23.21±10.70. All the patients had black dots, 98.6% had yellow dots, 27.1% had broken hair, 74.3% had tapering hair and only 71.4% had vellus hair. At baseline, 15 (21.4%) patients had Alopecia Grading Score (AGS) 1, 29 (41.4%) had score 2 and 26 (37.1%) had a score of 3. Injection Triamcinolone acetonide (5 mg/ml) was injected at 1 cm intervals with 0.1 ml on each site and the procedure was repeated every 4 weeks for a maximum period of 24 weeks. From baseline level to the last follow up, proportion of patients with black dots reduced from 100% to 4.3%, yellow dots from 98.6% to 0%, broken hair from 17% to 0% and tapering hair from 74.3% to 0%. Vellus hair increased from 71.4% to 100%. Overall success rate in terms of achievement of re-growth Ssore 4 at last follow up was 60%.Conclusions: Dermoscopic characteristics, such as black dots, yellow dots, broken hair, tapering hair and clustered short vellus hair are primary indicators of alopecia areata.

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

“…There was a significant improvement in all dermoscopic findings of AA observed from the first session and become more significant at the end of the study. This agrees with the study of Srivastava et al (21) and Ganjoo and Thappa (1) who demonstrated early response to intralesional corticosteroid by dermoscopy, where 67% of the patches showed maximum dermoscopic change by 8 weeks and 91% of the patches showed maximum dermoscopic change by 12 weeks.…”

“…In our study, there was statistically significant clinico-dermoscopic relation between hair regrowth and dermoscopic findings at the end of the study, where hair regrowth was more in cases with negative dermoscopic findings of AA as in the study of Srivastava et al (21) who reported significant clinico-dermoscopic relation between regrowth scale and dermoscopic findings reduction.…”

Intralesional methotrexate versus triamcinolone acetonide for localized alopecia areata treatment: A randomized clinical trial

“…This is in contrast to other studies showing cumulative effect of TrA with passage of time like Ganjoo et al, 14 who achieved RGS of 4 within 24 weeks of initiating therapy in 95% of patients. A similar effect was also observed in Srivastava et al 16 with a progressive increase of RGS of 4 from 9% of patients at fourth month, to 40% at fifth month and 60% at sixth which reported no substantial side effects of TrA. They reported telangiectasia in 7.5% of cases and 4.6% had atrophy.…”

“…Side effects involved hyperpigmentation in nine patients, erythema in two patients, and erosions in one patient in MTX group, hypopigmentation in two patients, erythema in one patient, and atrophy in one patient in TrA group. Our study suggests that the use of intralesional MTX for AA in adults is safe and sparing the possible systemic adverse effects of MTX use.Similar results were observed in the study of Srivastava et al,16…”

Trichloroacetic acid 35% as a therapeutic line for localized patchy alopecia areata in comparison with intralesional steroids: Clinical and trichoscopic evaluation

“…Choosing the proper treatment for alopecia areata relies on considering the age of the patient as well as the extent of the disease 12 . Intralesional corticosteroid (ILCs) injection is a good option among adults, 13 and the efficacy is even better within the pediatric group 14 …”