Intralesional Triamcinolone Outperforms Methotrexate in Alopecia Areata, suggests research
A new clinical study published in the Journal of Cosmetic Dermatology revealed in a head-to-head trial that intralesional triamcinolone led to significantly greater hair regrowth and patient satisfaction when compared to methotrexate in localized alopecia areata (AA) treatment.
Alopecia areata affects millions worldwide, manifesting as sudden hair loss in small patches or, in severe cases, across the entire scalp. Corticosteroid injections, particularly with triamcinolone acetonide (TrA), are often the frontline treatment, while methotrexate (MTX), which is a drug with immune-suppressing properties, has been investigated as an alternative. However, few studies have directly compared their effectiveness.
In this trial, a total of 40 patients with localized AA were divided into a group receiving monthly TrA injections and the other group given MTX over a 3-month period. Their progress was evaluated for 6 months using the Severity of Alopecia Tool (SALT), along with trichoscopic imaging, side effect tracking, and patient satisfaction scores.
The patients who received TrA injections showed an average 54.36% improvement in SALT scores, which indicated significant hair regrowth. The individuals on MTX experienced an average 54.6% worsening in scores, which suggests further hair loss rather than recovery.
The trichoscopic findings of both groups showed some changes. However, the only statistically meaningful result was a reduction in black dots, a marker of active hair follicle damage, seen in the MTX group. Despite this, the broader clinical outcomes still leaned heavily in favor of TrA.
The patients occasionally reported mild redness or pigmentation changes at injection sites, but no severe complications emerged. Also, satisfaction levels differed sharply, where the patients rated their experience with TrA an average 7.1 out of 10, when compared to just 4.9 for MTX.
The research found that TrA remains the superior choice for localized AA, both in regrowth effectiveness and patient experience. While MTX demonstrated some biological activity under the microscope, its inconsistent and often negative clinical impact makes it unsuitable as a frontline therapy at this stage.
Overall, the findings noted that further studies could explore whether methotrexate might perform better in adjusted doses or as part of combination regimens, potentially broadening treatment options for patients resistant to steroids.
Source:
Ghandi, N., Rashidi, A., Saberi, F., Abedini, R., Tootoonchi, N., & Babaie, H. (2025). Is intralesional methotrexate an effective alternative to intralesional triamcinolone in alopecia areata? Findings from a randomized controlled trial. Journal of Cosmetic Dermatology, 24(8), e70367. https://doi.org/10.1111/jocd.70367
