Intralesional betamethasone as a therapeutic option for alopecia areata

Corticosteroid Atrophy Plaque on the Scalp Treated with 5-Fluourouracil and Bleomycin Infusion in the MMP Technique

Alopecia areata (AA) is a disease with a great impact on quality of life of patients. Among several treatment modalities, intralesional injectable corticosteroid therapy is the first option, with corticosteroid-induced cutaneous atrophy as a common adverse event. We describe a case of plaque AA in the frontal region of the scalp that evolved with cutaneous atrophy induced by the application of intralesional corticosteroids but presented complete and sustained repilation after being treated with 5-Fluorouracil and Bleomycin using the technique of MMP (Microinfusion of Medicines into the Skin).

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

BACKGROUND

Multiple therapeutic modalities are available for alopecia areata (AA) but still a challenging disease with variable severity, recurrence, and a major cosmetic concern.

AIMS

Compare the effectiveness and safety of intralesional methotrexate (MTX) versus triamcinolone acetonide (TrA) in the treatment of localized AA in adults, both clinically and trichoscopically.

PATIENTS/METHODS

40 adult patients with localized AA were recruited and divided into two groups. 20 patients were treated by intralesional TrA and the other 20 patients were treated by intralesional MTX every 3 weeks, for maximum four sessions. Clinical and trichoscopic evaluation at baseline, each session and for 3 months after the last session was performed.

RESULTS

At the end of sessions (12 weeks), regrowth scale was significantly higher in TrA group compared to MTX group (p-value = 0.028). But, after 3-month follow-up, regrowth scale was higher in MTX group compared to TrA group (p-value = 0.153). A statistically significant reduction in AA specific trichoscopic signs after 12 weeks and at the 3-month follow-up in both groups. Local adverse events in both groups were transient and disappeared during the follow-up period.

CONCLUSION

Intralesional MTX in treatment of localized AA in adults can be promising and comparable to intralesional TrA with the need for further controlled and extensive trials. Trichoscopy can reveal early clinical response through disappearance of AA-specific trichoscopic signs and also early detection of adverse effects.

Innovative use of concentrated growth factors combined with corticosteroids to treat discoid lupus erythematosus alopecia: A case report

Alopecia for patients with discoid lupus erythematosus can sometimes be a refractory condition, where mixed infiltrates of T lymphocytes and histiocytes leads to destruction of hair follicles, which might cause permanent scarring. Early diagnosis and timely treatment can achieve hair regeneration and prevent further disease progression. Concentrated growth factor, a novel autologous plasma extract, contains various growth factors that could promote tissue regeneration. In this article, we report a case of cell growth factor combined with corticosteroids for the treatment of discoid lupus erythematosus alopecia. This case study concludes with satisfactory clinical effect.

Intralesional betamethasone versus triamcinolone acetonide in the treatment of localized alopecia areata: a within-patient randomized controlled trial

BACKGROUND

Betamethasone can be used for intralesional infiltration, but there is little evidence in the literature to indicate its effectiveness in alopecia areata.

OBJECTIVE

To assess the safety and effectiveness of the use of different doses of intralesional betamethasone, when compared to triamcinolone acetonide for the treatment of alopecia areata.

METHODS

We recruited 12 patients with alopecia patch divided into four quadrants. Each quadrant, after randomization, received an intralesional injection with one of the following treatments: triamcinolone acetonide 2.5 mg/ml, betamethasone 0.375 mg/ml, betamethasone 1.75 mg/ml, or 0.9% saline (placebo). The intervention was repeated in the same quadrant every 4 weeks, totaling 3 sessions. Visual and dermoscopic evaluation of the results were performed. Trial registration: ReBec RBR-5kyg2r.

RESULTS

At 4 and 8 weeks of intervention, triamcinolone acetonide 2.5 mg/ml provided the best visual results. Nevertheless, at the end of the study, the best visual results were seen with both triamcinolone acetonide and betamethasone 1.75 mg/ml, with significant difference when compared to betamethasone 0.375 mg/ml and placebo (p=.0489 and <.0001, respectively). There was a progressive reduction in the number of dystrophic hairs in all quadrants.

CONCLUSION

Triamcinolone acetonide shows earlier results in repilation, but at 12 weeks betamethasone 1.75 mg/ml had similar results.

Consensus on the treatment of alopecia areata - Brazilian Society of Dermatology

BACKGROUND

Alopecia areata is a highly frequent disease with an impact on quality of life and several treatment options with little clinical confirmatory evidence.

OBJECTIVE

To disseminate the recommendations of Brazilian dermatologists with expertise in the treatment of alopecia areata.

METHODS

Eight specialists with expertise in alopecia areata from different university centers were appointed by the Brazilian Society of Dermatology to reach a consensus on its treatment. Based on the adapted DELPHI methodology, the relevant elements were considered; then, an analysis of recent literature was carried out and the consensus was written down. Consensus on the management of alopecia areata was defined with the approval of at least 70% of the panel.

RESULTS/CONCLUSIONS

Intralesional injectable corticotherapy was considered the first option for localized disease in adults. In extensive cases with signs of activity, systemic corticosteroid therapy should be considered and can be used together with immunosuppressants (corticosteroid-sparing agents). The use of an immunosensitizer (diphencyprone) is an option for stable long-term cases. Evaluation of side effects is as important as the rate of hair regrowth.

Use of vibrating anesthetic device reduces the pain of mesotherapy injections: A randomized split-scalp study

Pain evaluation during local injections is a complex process. Injections cause patient's distress, especially when the target is a sensitive area such as scalp. Nonpharmacological methods as vibration before and during the procedure have been used to reduce pain. Mesotherapy has become a popular nonsurgical procedure for nonscarring alopecia, such as androgenetic alopecia (AGA) and alopecia areata (AA). Vibration has been successfully used in dermatological procedures, pediatrics, and dentistry. No study was found on vibration anesthesia during scalp mesotherapy. To analyze the effect of a vibration anesthetic device (VAD) during scalp mesotherapy on the patients' comfort.This is a randomized split-scalp study; thirty patients received mesotherapy with or without VAD on half of their scalp. Numerical rating scale (NRS) was used to measure self-reported pain. To test difference in means and medians in comparing device use and by treatment (AGA or AA), Student's t tests and Wilcoxon signed rank tests were used. Overall mean pain score on the no vibration-assisted side was 8.0 ± 1.0 while pain score for the vibration side was 2.3 ± 1.5, for AGA (P < .001) and 7.4 ± 1.2 and 2.1 ± 1.3, respectively, for AA (P < .001). Findings were similar for medians. No complications were found following procedure. To the best of our knowledge, this is the first study analyzing the effect of VAD in patients undergoing scalp mesotherapy. The VAD technique was found to be safe, effective, simple, and suitable for scalp procedures.