Intralesional Methotrexate for Treatment of Alopecia Areata: Clinical Evaluation and Effect on Lesional TNF Alpha

Abstract

Abstract Background Alopecia areata (AA) is an organ-specific autoimmune disease characterized by T-cell infiltrates and cytokine production including tumor necrosis factor alpha (TNF-α). Methotrexate causes T cell apoptosis and adenosine release that involves inhibition of TNF-α that could be the mechanism of action in AA. Aim of the Work To assess the efficacy of intralesional methotrexate in the treatment of alopecia areata and study its effect on TNF alpha tissue levels compared to before. Patients and Methods 30 patients were injected by intralesional methotrexate every two weeks for 3 months and a scalp biopsy was taken before and after treatment to measure lesional TNF-α. Results There was significant hair regrowth after methotrexate treatment with significant decrease in lesional TNF-α. Conclusion Intralesional methotrexate is an effective treatment for alopecia areata with mechanism of action involving decrease of TNF-α.