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

This study evaluated the efficacy of intralesional methotrexate (IL-MTX) in treating patchy alopecia areata (AA) in 15 patients. Over 3 months, patients received IL-MTX every 2 weeks, and scalp biopsies were conducted to measure tumor necrosis factor alpha (TNF-α) levels before and after treatment. Results showed a significant reduction in the severity of alopecia, with a 50% improvement rate and a notable decrease in TNF-α levels. Six months post-treatment, 46.7% of participants exhibited an excellent response, and 53.3% showed a good response, with no poor responses. Additionally, there was a significant decrease in exclamation mark hairs, black dots, broken hairs, and yellow dots, while vellus and terminal hairs significantly increased. The study concludes that IL-MTX is effective for patchy AA, likely by reducing TNF-α tissue levels.