How effective is intralesional injection of triamcinolone acetonide compared with topical treatments in inducing and maintaining hair growth in patients with alopecia areata? A Critically Appraised Topic

Abstract

QuestionHow effective is intralesional injection of triamcinolone acetonide compared with topical treatments in inducing and maintaining hair growth in patients with alopecia areata? Clinical scenarioA 23-year-old man with an 18-month history of patch-type alopecia areata (AA) of his scalp has failed to respond to topical clobetasol propionate and tacrolimus ointments. He enquired about intralesional steroid injections and wondered if this would be helpful in the treatment of his condition, which is causing a lot of concern and having a considerable psychological impact to the extent of preventing an active social life owing to embarrassment and low self-esteem.

Beard alopecia areata: a multicentre review of 55 patients

“…The development of AA has an important genetic component and positive family history has been reported to be between 4% and 28%, or even higher in other reports . In our series, 14.5% of patients presented family history of AA.…”

“…The treatment is not curative. Different therapies are used, including immunosuppressive drugs, systemic glucocorticoids, intradermal injections of triamcinolone acetonide and immunotherapy with diphenylcyclopropenone . Severity of AA at time of first consultation is an important prognostic factor and response to treatment is associated with better prognosis …”

Novel therapies for alopecia areata: The era of rational drug development

“…4 Clinical response (defined as > _50% improvement in the Severity of Alopecia Tool score) with intralesional triamcinolone is usually in the range of 50% to 80% and has been reported to reach as high as 97%. 5,6 Intralesional triamcinolone is usually tried for 6 months before moving the patient on to second-line therapies. Side effects of topical corticosteroids can include folliculitis, and intralesional corticosteroids can be associated with dermal atrophy or telangiectasia.…”

How to write a Critically Appraised Topic: evidence to underpin routine clinical practice

“…In summary, the careful construction of a clinical question using the PICO format ensures that the CAT remains linked to the original clinical scenario encountered and facilitates subsequent searching for the relevant evidence. Examples of PICO questions from CATs published in the BJD are shown in Table …”