Combination use of triamcinolone acetonide and immunotherapy as a new therapeutic option in alopecia totalis

Abstract

Alopecia totalis (AT) with body hair loss is the most severe type of alopecia areata (AA). The ability to develop hair is suggested to be poor in such severe AA, because AT does not respond to corticosteroid pulses and immunotherapy using squaric acid dibutylester (SADBE) or diphenylcyclopropenone (DPCP). The purpose of this study is to assess the possibility of hair regrowth in AT with body hair loss. Ten patients with AT who did not respond to topical immunotherapies, received triamcinolone acetonide (TA) injections. Undiluted or 2-fold diluted solutions of TA were prepared and 0.1–0.2 mL of either of the two solutions was administered to each patient. In total, 2 mL of the selected solution was injected monthly into each area. In cases where vellus hair developed after the injections, we restarted the immunotherapy using SADBE or DPCP and continued the therapies for more than half a year. The development of vellus hair after TA injections was defined as a good response. Complete response rate to the topical injection of TA was 10% (1/10), however the partially good response rate was 60% (6/10). The good responders showed the anagen stage of hair follicle after TA injections. Furthermore, the complete responder to TA showed susceptibility to the subsequent immunotherapy and more regrowth of hair was seen. Even if patients with AT have suffered for a prolonged period since onset, it is possible to recover the hair cycle if they show susceptibility to intralesional corticosteroid and subsequent immunotherapy.