Intralesional methotrexate versus triamcinolone acetonide for localized alopecia areata treatment: A randomized clinical trial.

BACKGROUND: Multiple therapeutic modalities are available for alopecia areata (AA) but still a challenging disease with variable severity, recurrence, and a major cosmetic concern. AIMS: Compare the effectiveness and safety of intralesional methotrexate (MTX) versus triamcinolone acetonide (TrA) in the treatment of localized AA in adults, both clinically and trichoscopically. PATIENTS/METHODS: 40 adult patients with localized AA were recruited and divided into two groups. 20 patients were treated by intralesional TrA and the other 20 patients were treated by intralesional MTX every 3 weeks, for maximum four sessions. Clinical and trichoscopic evaluation at baseline, each session and for 3 months after the last session was performed. RESULTS: At the end of sessions (12 weeks), regrowth scale was significantly higher in TrA group compared to MTX group (p-value = 0.028). But, after 3-month follow-up, regrowth scale was higher in MTX group compared to TrA group (p-value = 0.153). A statistically significant reduction in AA specific trichoscopic signs after 12 weeks and at the 3-month follow-up in both groups. Local adverse events in both groups were transient and disappeared during the follow-up period. CONCLUSION: Intralesional MTX in treatment of localized AA in adults can be promising and comparable to intralesional TrA with the need for further controlled and extensive trials. Trichoscopy can reveal early clinical response through disappearance of AA-specific trichoscopic signs and also early detection of adverse effects.

Fractional versus full ablative CO2 laser in recipient site of non-cultured melanocytes and keratinocyte transplantation in treatment of vitiligo.

BACKGROUND: Melanocyte-keratinocyte transplant procedure (MKTP) or non-cultured epidermal cell suspension transplantation is a very popular surgical modality for treating stable vitiligo. The recipient-site preparation is one potential determinant in the repigmentation outcomes. AIM: To assess the efficacy of fractional CO2 (FCO2 ) laser in recipient-site preparation before MKTP and comparing it to the frequently used full surface laser ablation. METHODS: This randomized comparative trial included 19 patients with 40 stable vitiligo lesions. In each patient, the treated sites were randomly categorized into two groups according to the recipient-site ablation (either fractional or full ablative CO2 laser). Assessment of repigmentation was performed six months after the procedure. RESULTS: Both modalities achieved successful repigmentation of a median of 80% and 77.5% for fractional and full ablation groups, respectively, with a non-statistically significant difference between them. The median of VASI change percent was -73% and -71% with fractional and full surface ablation, respectively. CONCLUSIONS: FCO2 laser ablation is effective for recipient-site preparation before cell suspension transplantation as well as the full ablative CO2 laser.