Intra-Individual Comparative Study of Methotrexate versus Triamcinolone Acetonide Delivered via Microneedling for Recalcitrant Alopecia Areata

This study compared the efficacy and safety of methotrexate and triamcinolone acetonide, both delivered via microneedling, in 34 patients with recalcitrant alopecia areata. Over 12 weeks, patients received treatments on different patches of hair loss. Results showed that methotrexate-treated areas had significantly greater reductions in Severity of Alopecia Tool (SALT) scores, higher patient satisfaction, and lower relapse rates compared to triamcinolone-treated areas. Both treatments were well tolerated with only mild, transient adverse effects. The study concludes that microneedling-assisted methotrexate may offer superior short-term outcomes, suggesting the need for larger trials to confirm these findings and assess long-term effects.