Treatment of severe alopecia areata with intralesional steroid injections.
BACKGROUND
Treatment of alopecia areata with intralesional steroid injection is generally recommended for people who have less than 50% scalp involvement. In a specialized hair loss clinic, the authors successfully treated patients with extensive alopecia areata (over 50% but under 99%) with intralesional corticosteroid injections.


METHODS
A review of patients with extensive alopecia areata was done. Six out of 10 patients responded to treatment with intralesional triamcinolone acetonide. In comparison to the non-responders, the responders tended to have exclamation mark hairs and a positive hair pull test at their initial physical examination, and exhibited improvement during the initial months of treatment. Complications were negligible, with mild reversible atrophy in three patients. The treatment was well tolerated and, in some patients, pain was minimized by use of a topical anesthetic agent applied under occlusion prior to the visit.


CONCLUSIONS
Intralesional triamcinolone acetonide is a safe and effective treatment for patients with extensive alopecia areata. Patients with exclamation point hairs and a positive hair pull test may be more likely to respond.
Department of Dermatology, Boston University School of Medicine, Boston, MA, USA. Kyung.Chang@bmc.org
Kyung Hee
KH
Chang
Salinee
S
Rojhirunsakool
Lynne J
LJ
Goldberg
D000293:Adolescent; D000328:Adult; D000506:Alopecia Areata / Q000188:drug therapy*; D000779:Anesthetics, Local / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D000779:Anesthetics, Local; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide