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Hamdino M, El-Barbary RA, Darwish HM. Intralesional methotrexate versus triamcinolone acetonide for localized alopecia areata treatment: A randomized clinical trial. J Cosmet Dermatol 2021; 21:707-715. [PMID: 33749975 DOI: 10.1111/jocd.14090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Mervat Hamdino
- Dermatology and Venereology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Rasha Aly El-Barbary
- Dermatology and Venereology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Hanan Mohammed Darwish
- Dermatology and Venereology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
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Fang H, Liu Q, Cheng T, Yang C, Wu R, Yang Z, Yang D. Innovative use of concentrated growth factors combined with corticosteroids to treat discoid lupus erythematosus alopecia: A case report. J Cosmet Dermatol 2021; 20:2538-2541. [PMID: 33356005 DOI: 10.1111/jocd.13904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/21/2020] [Accepted: 12/09/2020] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Huijuan Fang
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China.,Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
| | - Qingwu Liu
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Tiantian Cheng
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China.,Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
| | - Chaowei Yang
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Ruiying Wu
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China.,Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
| | - Zhishan Yang
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China.,Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
| | - Dingquan Yang
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
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de Sousa VB, Arcanjo FP, Aguiar F, Vasconcelos J, Oliveira AF, Honório A, Pontes J. Intralesional betamethasone versus triamcinolone acetonide in the treatment of localized alopecia areata: a within-patient randomized controlled trial. J DERMATOL TREAT 2020; 33:875-877. [PMID: 32594786 DOI: 10.1080/09546634.2020.1788703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Vando Barbosa de Sousa
- Post-Graduation Program in Health Sciences, Universidade Federal do Ceará, Sobral, Brazil
| | | | - Fernando Aguiar
- Department of Medicine, Universidade Federal do Piauí, Parnaíba, Brazil
| | - Jaqueline Vasconcelos
- Departmant of Dermatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Aline Honório
- Department of Medicine, Centro Universitário INTA, Sobral, Brazil
| | - Juliana Pontes
- Department of Medicine, Centro Universitário INTA, Sobral, Brazil
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Ramos PM, Anzai A, Duque-Estrada B, Melo DF, Sternberg F, Santos LDN, Alves LD, Mulinari-Brenner F. Consensus on the treatment of alopecia areata - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:39-52. [PMID: 33183894 PMCID: PMC7772599 DOI: 10.1016/j.abd.2020.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/15/2020] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Paulo Müller Ramos
- Department of Dermatology and Radiotherapy, Universidade Estadual Paulista, Botucatu, SP, Brazil.
| | - Alessandra Anzai
- Department of Dermatology, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Bruna Duque-Estrada
- Centro de Estudos dos Cabelos, Instituto de Dermatologia Prof. Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Daniel Fernandes Melo
- Department of Dermatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Flavia Sternberg
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Leopoldo Duailibe Nogueira Santos
- Department of Medicine, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Dermatology and Allergology, Hospital do Servidor Público Municipal, São Paulo, SP, Brazil
| | - Lorena Dourado Alves
- Department of Tropical Medicine and Dermatology, Universidade Federal de Goiás, Goiânia, GO, Brazil
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Carvalho RDM, Barreto TDM, Weffort F, Machado CJ, Melo DF. Use of vibrating anesthetic device reduces the pain of mesotherapy injections: A randomized split-scalp study. J Cosmet Dermatol 2020; 20:425-428. [PMID: 32640097 DOI: 10.1111/jocd.13554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/09/2020] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
| | | | - Flavia Weffort
- University of State of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Carla Jorge Machado
- Preventive and Social Medicine Department, Federal University of Minas Gerais, Minas Gerais, Brazil
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