Intramuscular triamcinolone acetonide: An undervalued option for refractory alopecia areata

Severe alopecia areata ( AA ) can have an unpredictable clinical course and become refractory to contact immunotherapy. Novel treatment options include low‐dose interleukin‐2 and Janus kinase inhibitors; however, these treatments are still under investigation. Therefore, we evaluated the efficacy and safety of intramuscular (i.m.) triamcinolone acetonide ( TAC ) as a rescue therapy for refractory AA . We retrospectively analysed efficacy, adverse effects and relapse rate of i.m. TAC monthly in 27 patients with refractory AA . We defined AA as refractory if the patient showed an unsatisfactory response to both systemic treatment (not i.m. TAC ) and the consecutive diphenylcyclopropenone immunotherapy. The initial systemic treatment of other forms of corticosteroids and/or cyclosporin was used to control extensive AA involving more than 25% of the scalp. Administration of i.m. TAC for 3–6 months resulted in a 63.0% response rate, and all patients showed inactive disease after treatment. Final hair regrowth negatively correlated with initial scalp involvement (Spearman r = −0.595, P = 0.001). All patients showed complete recovery of adrenocortical reserve within 3 months after the last injection. Adverse effects of systemic steroid therapy were observed only in female patients (dysmenorrhea and osteoporosis). i.m. TAC may provide a valuable therapeutic option to manage active hair loss and facilitate hair regrowth in refractory AA , especially in male patients.