{"title":"The optimal concentration of intralesional triamcinolone acetonide for patchy alopecia areata: A systematic review and meta-analysis","authors":"Hsuan-An Su, Yu-Tsung Chen, Yu-Chia Chen","doi":"10.4103/ds.ds_15_22","DOIUrl":null,"url":null,"abstract":"Background: Intralesional steroid treatment for alopecia areata (AA) has been developed for decades, yet the optimal concentration of triamcinolone acetonide (TrA) is not well-established. Objectives: This review aims to determine the optimal concentration of intralesional TrA in treating patchy AA. Methods: We conducted a systematic review and meta-analysis, and searched the Cochrane Library, Embase, and PubMed databases on July 4, 2021, to identify randomized or nonrandomized comparative studies reporting the response rates and/or adverse events among AA patients treated with various concentrations of TrA. The meta-analysis of proportions and odds ratios was analyzed using random-effects modeling. Results: Nineteen studies and a total of 783 participants were included. The estimated response rate of 5 mg/dl (74.82%, 95% confidence interval [CI] 64.99%–83.50%) was shown to be more efficacious than 2.5/3.33 mg/dl (38.64%, 95% CI 16.98%–62.99%) but similar to 10 mg/dl (71.06%, 95% CI 59.72%–81.20%), while pooled estimate of odds ratios revealed higher efficacy with 10 mg/dl than 5 mg/dl (odds ratio = 1.64, 95% CI 1.05–2.58, P = 0.031). The rates of skin atrophy were 18.05% (95% CI, 10.32%–27.38%), 11.49% (95% CI, 2.86%–24.84%), and 3.85% (95% CI, 1.27%–14.01%) in groups 10, 5, and 2.5/3.33 mg/dl, respectively. Higher concentration is associated with more skin atrophy in a dose-dependent fashion (P = 0.012). Heterogeneity among studies in the meta-analyses was high. Conclusion: The optimal intralesional concentration of TrA for patchy AA is probably 10 mg/dl with acceptable adverse events.","PeriodicalId":11107,"journal":{"name":"Dermatologica Sinica","volume":"198 1","pages":"85 - 93"},"PeriodicalIF":2.3000,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Dermatologica Sinica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4103/ds.ds_15_22","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"DERMATOLOGY","Score":null,"Total":0}
引用次数: 1
Abstract
Background: Intralesional steroid treatment for alopecia areata (AA) has been developed for decades, yet the optimal concentration of triamcinolone acetonide (TrA) is not well-established. Objectives: This review aims to determine the optimal concentration of intralesional TrA in treating patchy AA. Methods: We conducted a systematic review and meta-analysis, and searched the Cochrane Library, Embase, and PubMed databases on July 4, 2021, to identify randomized or nonrandomized comparative studies reporting the response rates and/or adverse events among AA patients treated with various concentrations of TrA. The meta-analysis of proportions and odds ratios was analyzed using random-effects modeling. Results: Nineteen studies and a total of 783 participants were included. The estimated response rate of 5 mg/dl (74.82%, 95% confidence interval [CI] 64.99%–83.50%) was shown to be more efficacious than 2.5/3.33 mg/dl (38.64%, 95% CI 16.98%–62.99%) but similar to 10 mg/dl (71.06%, 95% CI 59.72%–81.20%), while pooled estimate of odds ratios revealed higher efficacy with 10 mg/dl than 5 mg/dl (odds ratio = 1.64, 95% CI 1.05–2.58, P = 0.031). The rates of skin atrophy were 18.05% (95% CI, 10.32%–27.38%), 11.49% (95% CI, 2.86%–24.84%), and 3.85% (95% CI, 1.27%–14.01%) in groups 10, 5, and 2.5/3.33 mg/dl, respectively. Higher concentration is associated with more skin atrophy in a dose-dependent fashion (P = 0.012). Heterogeneity among studies in the meta-analyses was high. Conclusion: The optimal intralesional concentration of TrA for patchy AA is probably 10 mg/dl with acceptable adverse events.
期刊介绍:
Dermatologica Sinica aims to publish high quality scientific research in the field of dermatology, with the goal of promoting and disseminating dermatological-related medical science knowledge to improve global health. Articles on clinical, laboratory, educational, and social research in dermatology and other related fields that are of interest to the medical profession are eligible for consideration. Review articles, original articles, brief reports, case reports and correspondence are accepted.