Intralesional Methotrexate Is Comparable to Triamicinolone Acetonide and Superior to Vitamin D3 in the Treatment of Alopecia Areata

Background: Even with a variety of treatment options, alopecia areata (AA) remains a difficult condition to manage. Objective: To evaluate the efficacy of intralesional methotrexate (MTX) versus Vitamin D3 and triamcinolone acetonide (TrA) in the treatment of AA. Materials and Methods: Ninety individuals with AA of <50% scalp affection were enrolled. They were separated evenly into three groups based on the injected drug: group (A): TrA, group (B): MTX, and group (C): vitamin D3. Intralesional injections were administered every 3 weeks for a maximum of four sessions, or until total hair regrowth occurred, whichever came first. Response was evaluated using the severity of alopecia tool (SALT) score, semi-quantitative regrowth score, trichoscopy, and digital photography. Results: The TrA and MTX groups had a significantly earlier initial response than the Vitamin D3 group ( P < 0.001). After 12 weeks of treatment, there was a significant reduction of SALT score in the TrA and MTX groups compared to the Vitamin D3 group ( P < 0.001). The percentage of hair regrowth in the TrA and MTX groups was significantly higher than in the Vitamin D3 group after 12 weeks ( P < 0.001). Regarding the trichoscopic findings, the yellow dots and exclamation marks were significantly less frequent in the TrA and MTX groups than in the Vitamin D3 group after 9 weeks of treatment. Conclusion: Intralesional MTX demonstrated significant efficacy compared to Vitamin D3 in the treatment of AA.