title: Intramuscular triamcinolone acetonide: An undervalued option for refractory alopecia areata.
abstract: Severe alopecia areata (AA) can have an unpredictable clinical course and become refractory to contact immunotherapy. Novel treatment options include low-dose interleukin-2 and Janus kinase inhibitors; however, these treatments are still under investigation. Therefore, we evaluated the efficacy and safety of intramuscular (i.m.) triamcinolone acetonide (TAC) as a rescue therapy for refractory AA. We retrospectively analysed efficacy, adverse effects and relapse rate of i.m. TAC monthly in 27 patients with refractory AA. We defined AA as refractory if the patient showed an unsatisfactory response to both systemic treatment (not i.m. TAC) and the consecutive diphenylcyclopropenone immunotherapy. The initial systemic treatment of other forms of corticosteroids and/or cyclosporin was used to control extensive AA involving more than 25% of the scalp. Administration of i.m. TAC for 3-6 months resulted in a 63.0% response rate, and all patients showed inactive disease after treatment. Final hair regrowth negatively correlated with initial scalp involvement (Spearman r = -0.595, P = 0.001). All patients showed complete recovery of adrenocortical reserve within 3 months after the last injection. Adverse effects of systemic steroid therapy were observed only in female patients (dysmenorrhea and osteoporosis). i.m. TAC may provide a valuable therapeutic option to manage active hair loss and facilitate hair regrowth in refractory AA, especially in male patients.
authors.affiliation: Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jimyung
authors.initials: J
authors.lastname: Seo
authors.affiliation: Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young In
authors.initials: YI
authors.lastname: Lee
authors.affiliation: Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Shinwon
authors.initials: S
authors.lastname: Hwang
authors.affiliation: Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.|Department of Dermatology, Yanbian University Hospital, Yanji, China.
authors.forename: Zhenlong
authors.initials: Z
authors.lastname: Zheng
authors.affiliation: Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000506:Alopecia Areata / Q000188:drug therapy*; D002648:Child; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide
keywords: adverse effects; alopecia areata; intramuscular triamcinolone acetonide; relapse; steroids