Intralesional Methotrexate in Patchy Alopecia Areata: Trichoscopic Evaluation and Effect on Lesional Tumor Necrosis Factor Alpha

This study assessed the efficacy of intralesional methotrexate (IL-MTX) in treating patchy alopecia areata in 15 patients, showing significant hair regrowth and a decrease in the Severity of Alopecia Tool (SALT) score at 3 and 6 months post-treatment. At 3 months, 40% of patients had an excellent response, increasing to 46.7% at 6 months, with no poor responses. IL-MTX also reduced tumor necrosis factor alpha (TNF-α) levels by 50%, indicating its potential as an effective treatment with minimal side effects. However, 26.7% of patients experienced relapse, and the small sample size is a limitation. The study suggests IL-MTX as a safer alternative to corticosteroids, though longer treatment may be necessary to prevent relapse.