536 Systematic review and meta-analysis evaluating the effectiveness of different concentrations of intralesional triamcinolone for alopecia areata

Abstract

While intralesional steroids are considered first-line treatment for focal alopecia areata, the optimal concentration of intralesional triamcinolone is not known due to the paucity of randomized controlled trials. The current literature is mostly limited to case series with small sample sizes and heterogeneous populations. Therefore, we performed a systematic review and meta-analysis evaluating the efficacy and tolerability of different concentrations of intralesional triamcinolone for alopecia areata. We conducted a comprehensive literature search of MEDLINE and EMBASE, identifying observational cohort studies and randomized controlled trials reporting rates of hair regrowth with intralesional triamcinolone for alopecia areata. Random-effects modeling was used to obtain pooled effect sizes with 95% confidence intervals. Of 3,438 studies screened, a total of six studies (443 participants) with alopecia areata were included in the analysis. Pooled rates of hair regrowth were 62.3% (CI: 50.6-72.8%, p=0.04) at <5 mg/ml, 80.9% (CI: 71-88%, p<0.005) at 5 mg/ml, and 79.9% (CI: 61.9-90.7%, p=0.003) at 10 mg/ml concentrations of intralesional triamcinolone. Skin atrophy occurred in 4/120 (3.33%) treated with 5 mg/ml and 12/59 (20%) treated with 10 mg/ml concentration. Based on our meta-analysis, rates of hair regrowth were comparable with 5 mg/ml and 10 mg/ml concentrations (80.9%, p<0.005 versus 79.9%, p=0.003, respectively) while rate of hair regrowth (62.3%, p=0.04) was lower with <5 mg/ml concentrations of intralesional triamcinolone for treatment of focal alopecia areata. Interestingly, in contrast to our findings, a pilot intra-subject study of 4 participants demonstrated comparable rates of hair regrowth in 2.5 mg/ml, 5 mg/ml, and 10 mg/ml concentrations. Given risk for adverse side effects like skin atrophy with higher concentrations of intralesional steroids, additional studies are needed to determine the lowest effective concentration for the treatment of alopecia areata.