Efficacy of intralesional methotrexate in the treatment of alopecia areata

Background Alopecia areata (AA) treatment is still challenging as multiple treatment options are available, but there is no fully curative or preventive treatment. Aim To evaluate the efficacy and safety of intralesional methotrexate (MTX) in the treatment of localized AA both clinically and dermoscopically. Patients and methods A total of 30 patients aged 18–55 years with localized AA were enrolled in this study. Each patient was treated by intralesional MTX (25 mg/ml) at 2-week intervals for four sessions and followed up for 3 months. The target lesions were evaluated clinically using regrowth scale and dermoscopically at the end of sessions, 1, 2, and 3 months after treatment. Results At the end of study, the response rate to intralesional MTX was ∼93.3%, and 15 (50.0%) patients showed a score of 4 (regrowth ≥75%). There was a statistically significant difference in regrowth scale between end of sessions, 4, 8, and 12 weeks of follow-up. There was also statistically significant reduction in dermoscopic parameters at the end of sessions, 4, 8, and 12 weeks of follow-up with a significant clinicodermoscopic relation between regrowth scale and dermoscopic findings. No patient (0.0%) showed recurrence. Conclusion Intralesional MTX can be an effective and safe therapeutic option for localized AA with no significant adverse effects. Dermoscopy can be used for evaluating the response of AA lesion to treatment.