Randomized Study to Evaluate the Efficacy of Platelet Rich Plasma, Intralesional Triamcinolone Acetonide and Intralesional Normal Saline in Moderate to Severe Alopecia Areata

Abstract

BACKGROUND
 Alopecia areata (AA) is a common, chronic, autoimmune, inflammatory disease that causes non scarring hair loss. Treatment of moderate to severe AA is challenging without a definitive cure. This study was undertaken to compare the efficacy of platelet rich plasma (PRP) - a novel procedural therapy, intralesional triamcinolone acetonide (ILS) and intralesional normal saline (NS) in moderate to severe AA.
 METHODS
 A total of 75 patients clinically diagnosed with Alopecia Areata were enrolled and the severity of the disease was assessed by SALT score. Twenty-five patients each in Group A, B and C were treated with PRP, ILS and NS respectively at monthly intervals for four sessions. Improvement in hair regrowth (based on reduction in SALT SCORE) and adverse effects were noted in all cases in each group at each session and one month after the final sitting. Statistical analysis was done using the student's t-test for quantitative values and the chi-square test for qualitative values.
 RESULTS
 Males outnumbered females with a percentage of 74.7, whereas females were 25.3 %. Male: female ratio of 2.9:1. Patchy type of AA was the most common clinical type observed (54.66 %), followed by sub totalis (14.66 %). Forty-eight cases (64 %) had a severity grade of S2 (26-50) followed by twenty-three cases (30 %) grade of S3 (51-75). After 20 weeks of treatment, the mean percentage of SALT score improvement with the highest efficacy was seen in the ILS group (63.15 %) followed by the PRP group (37.51 %). Improvement of hair regrowth with the excellent response (66 %) was achieved in ILS followed by 33 % in the PRP group, comparatively rapid reduction in SALT SCORE within four weeks was observed in the ILS group whereas gradual reduction in SALT SCORE was achieved in 8-12 weeks in PRP group. Relapse was seen in 21.7 % of patients in the ILS group and 1 (4.1 %) patient in the PRP group in the follow-up period of four months. No major adverse effects were seen in any of the groups.
 CONCLUSIONS
 Efficacy of ILS was more significant than PRP and Placebo but with a higher recurrence rate. Both treatments were extremely safe, with no significant adverse effects.