Randomized comparison of topical betamethasone valerate foam, intralesional triamcinolone acetonide and tacrolimus ointment in management of localized alopecia areata

Abstract

Background:Alopecia areata (AA) is a common, non-scarring, patchy loss of hair at scalp and elsewhere. Its pathogenesis is uncertain; however, auto-immunity has been exemplified in various studies. Familial incidence of AA is 10-42%, but in monozygotic twins is 50%. Local steroids (topical / intra-lesional) are very effective in treatment of localized AA.Aim:To compare hair regrowth and side effects of topical betamethasone valerate foam, intralesional triamcinolone acetonide and tacrolimus ointment in management of localized AA.Materials and Methods:105 patients of localized AA were initially registered but 27 were drop out. So, 78 patients allocated at random in group A (28), B (25) and C (25) were prescribed topical betamethasone valerate foam (0.1%) twice daily, intralesional triamcinolone acetonide (10mg/ml) every 3 weeks and tacrolimus ointment (0.1%) twice daily, respectively, for 12 weeks. They were followed for next12 weeks. Hair re-growth was calculated using “HRG Scale”; scale I- (0-25%), S II-(26-50%), S III - (51-75%) and S IV- (75-100%).Results:Hair re-growth started by 3 weeks in group B (Scale I: P<0.03), turned satisfactory at 6 weeks in group A and B (Scale I: P<0.005, Scale IV: P<0.001)), good at 9 weeks (Scale I: P<0.0005, Scale IV: P<0.00015), and better by 12 weeks of treatment (Scale I: P<0.000021, Scale IV: P<0.000009) in both A and B groups. At the end of 12 weeks follow-up hair re-growth (>75%, HRG IV) was the best in group B (15 of 25, 60%), followed by A (15 of 28, 53.6%) and lastly group-C (Nil of 25, 0%) patients. Few patients reported mild pain and atrophy at injection sites, pruritus and burning with betamethasone valerate foam and tacrolimus.Conclusion:Intralesional triamcinolone acetonide is the best, betamethasone valerate foam is better than tacrolimus in management of localized AA.

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

“…In different studies reviewed by us too, no significant side effect of ILC therapy has been reported. 21,22,24,25,26 Kuldeep et al, in their study reported mild pain and atrophy at injection sites. 22 However, in present study, keeping in view the transitional nature of pain at injection site, it was not recorded as a side effect and the incidence of atrophy was almost rare.…”

“…25 Kuldeepet al, using almost the same inclusion and evaluation criteria as used in present study also obtained 60% success rate within 12 weeks of intralesional triamcinolone acetonide treatment. 22 In another study, Ganjooet al, found achievement of RGS of 4 within 12 weeks in 28/60 (46.7%) of their patients receiving intralesional Triamcinolone Acetonide and 57/60 (95%) within 24 weeks of treatment. 21 Their findings thus indicate the cumulative effect of treatment with passage of time.…”

“…Kuldeepet al, reported hair regrowth within 3 weeks, while using intralesional Triamcinolone Acetonide. 22 Ganjooet al too in their study using dermoscopic evaluation reported regrowth of new vellus hair and disappearance of tapering hair within 4 weeks. 21 All these reports indicate that intralesional Triamcinolone Acetonide provides an early response and is consistent with the present study.…”

An observational study of alopecia areata in Sri Lankan adult patients

“…A study done in Turkey did not find a significant difference between disease severity and personal or family history of autoimmune disease in adult and paediatric patients [8]. However a study from Taiwan found an association between comorbid conditions and age of onset of AA [9]. In 10-15% patients, the nails are involved.…”

“…Poor prognostic factors are, childhood onset atopy (personal or first-degree relatives), ophiasis pattern, extensive involvement, onychodystrophy and Down's syndrome [1,3,4,9]. Local steroids (topical or intralesional) are effective in treatment of localised AA [10].…”