Intralesional (IL) injection of corticosteroids is an effective treatment of alopecia areata (AA). A novel drug delivery technique that uses a tattoo machine (MMP®) has been successfully used to treat other skin disorders. We tested this technique to treat AA. We used the Cheyenne dermopigmentation machine (Anvisa 80281110016; Germany) with a 27 Magnum needle cartridge (Anvisa 80281110015) at a frequency of 70 Hz and needle depth of 1.0 mm. A triamcinolone acetonide (TAC) solution was placed in a sterile receptacle and loaded onto the cartridge by capillarity. We produced micropunctures of the skin with the medication-soaked needles until the affected area was covered by a bloody dew. Case 1: J.C.V., a male, with a diagnosis of AA in patches was treated with 1-monthly session with 2.5 mg/mL TAC delivered by MMP® (4 sessions in total). Case 2: L.M.V., a 78-year-old female with a diagnosis of AA was treated with 1-monthly session with 10 mg/mL TAC delivered by MMP® (4 sessions in total). MMP® is a novel technique that combines microneedling with drug delivery, and it could be used to deliver IL TAC to AA patients. This technique promotes a more uniform absorption of corticosteroids than traditional treatment methods of AA.

Purpose: To determine the relationship between pili annulati (PA) and acquired trichorrhexis nodosa (TN) seen in the same patient, considering the two main theories evoked by previous studies: greater stiffness of darker PA bands or associated cuticular damage. Procedures: Light microscopy of hair shafts from different regions of the patient's scalp. Results: TN was not superimposed to dark bands of PA. Conclusions: Greater stiffness of darker PA bands was excluded as the cause of hair breakage. Hair breakage in PA patients might be related to cuticular abnormalities, as previously reported. Because weathering of long thin chemically treated hairs is extremely common, coincidence cannot be completely ruled out in this case.

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<b><i>Introduction:</i></b> There are few reports involving scalp microneedling in MPHL patients, and in most of them, physical stimulus is associated with other therapeutic agents. The aim of this study was to evaluate the efficacy and risks of isolated scalp microneedling in MPHL patients. <b><i>Methods:</i></b> Thirty patients were included in this randomized single-blinded study and submitted to 4 monthly scalp microneedling sessions. Two different microneedling devices were used: roller (<i>n</i> = 15) and tattoo cartridge (<i>n</i> = 15). Scalp coverage and hair density changes were measured 4 and 16 weeks after the last session. Adverse events were observed throughout the study, and scalp biopsies were performed before and after to investigate scarring changes. <b><i>Results:</i></b> Four of 12 participants in the roller group and 2 of 14 participants in the tattoo cartridge group showed an improvement in clinical pictures at the first follow-up visit. Only half of these patients sustained an improvement until the last follow-up visit. No benefit in hair density was observed in either group. No reports of adverse events were made. Neocollagenesis and elastolysis were noted in scalp biopsies. <b><i>Discussion/Conclusion:</i></b> Isolated scalp microneedling did not show improvement in scalp coverage or hair density of MPHL participants in this study.