Patchy Hair Loss Research Articles

An unusual case of Anasarca-Rapunzel syndrome

Rapunzel syndrome is a rare form of gastric trichobezoar extending into the intestine, often associated with malnutrition and protein-losing enteropathy. A 12-year-old female presented with epigastric abdominal pain, facial puffiness, bilateral lower limb swelling, and anorexia. She was a known case of sickle-thalassemia double heterozygous state but had never received a blood transfusion. Family history revealed parental separation and harsh paternal behavior. The patient was undernourished but otherwise developed normally. On examination, she was lethargic, exhibited generalized anasarca, severe anemia, signs of congestive cardiac failure, and patchy hair loss on the scalp. Abdominal examination revealed moderate ascites, hepatosplenomegaly, and a firm, mobile, non-tender epigastric mass (10×8 cm), suggestive of gastric bezoar. Laboratory findings showed microcytic hypochromic anemia with macro-ovalocytes in the context of sickle-thalassemia heterozygosity. The child required multiple blood and serum albumin transfusions for severe anemia and hypoproteinemia with anasarca. Hepatic and renal causes of anasarca were excluded. Cardiovascular and respiratory systems were normal. Contrast enhanced computed tomography (CECT) abdomen confirmed the gastric bezoar. After stabilization, exploratory laparotomy and trichobezoar evacuation were performed. Psychiatric counseling and diversion therapy were provided. The child was discharged in stable condition, with follow-up showing significant improvement in nutritional status, mood, and general well-being. This case highlights the unusual presentation of Rapunzel syndrome with generalized anasarca in a pediatric patient with underlying sickle-thalassemia, emphasizing the importance of multidisciplinary management and follow-up.

54269 Patchy hair loss, hyperpigmented plaques, and hyperkeratotic papules in a middle aged woman

54269 Patchy hair loss, hyperpigmented plaques, and hyperkeratotic papules in a middle aged woman

Alopecia areata: Ayurvedic treatment in a tertiary care setup

Alopecia areata is a chronic disease characterized by excessive and patchy loss of hair from the scalp of a person. Although a lot of treatment options are available in the allopathy, the presence of various side effects and recurrence of hair loss after stopping the treatment reduces the effectiveness and hence prevents complete cure and increases the patient morbidity. Ayurvedic treatment options provide a better alternative for the management of alopecia areata due to lesser side effects and reduced relapse cases. This case enlightens how a patient of alopecia was effectively managed using ayurvedic medicines.

Post-herpetic neuralgia-associated patchy hair loss closely mimicking trichotillomania

Post-herpetic neuralgia-associated patchy hair loss closely mimicking trichotillomania

The correlation between corona virus disease 2019 and alopecia areata: a literature review.

Corona virus disease 2019(COVID-19) is one of the most serious respiratory pandemic diseases threatening human health for centuries. Alopecia areata (AA) is a sudden patchy hair loss, an autoimmune disease, which seriously affects the image and mental health of patients. Evidence shows that the risk of autoimmune diseases significantly increases after COVID-19, and is positively correlated with the severity, with a significant increase in the risk of alopecia in those over 40 years old. The relationship between COVID-19 and AA has become a hot topic of current research. Strengthening the research on the correlation between COVID-19 and AA can help to identify and protect susceptible populations at an early stage. This article reviews the research progress on the epidemiological background of COVID-19 and AA, the situation and possible mechanisms of AA induced by COVID-19 or COVID-19 vaccination, and potential treatment methods.

Characteristics, Clinical, and Trichoscopic Features in Pediatric Patients with Alopecia Areata: A Single-Center Observational Study at the Dermatology Clinic of Dr. M. Djamil General Hospital Padang

Background: Alopecia areata (AA) is an autoimmune disease that causes patchy hair loss. In children, AA can have a significant psychological impact. This study aims to identify the characteristics, clinical and trichoscopic features of AA pediatric patients at the dermatology clinic of Dr. M. Djamil General Hospital Padang. Methods: This cross-sectional analytical observational study involved pediatric patients (<18 years) with a diagnosis of AA who came to the dermatology clinic of Dr. M. Djamil General Hospital Padang between January 2020 to December 2023. Demographic data, disease history, clinical features, and trichoscopy examination results were collected and analyzed descriptively. Results: A total of 125 pediatric AA patients met the inclusion criteria. The majority of patients were female (62.4%) with a mean age of 10.5 years. The most common form of AA is patchy (80%), followed by alopecia totalis/universalis (12%) and ophiasis (8%). A history of atopy was found in 35.2% of patients. The most frequently found trichoscopic features were yellow dots (78.4%), black dots (64%), and broken hairs (56%). Conclusion: This study provides a comprehensive description of the characteristics, clinical and trichoscopic characteristics of AA pediatric patients at Dr. M. Djamil General Hospital Padang. These findings may provide a basis for the development of better management strategies for AA in children.

A Review of JAK Inhibitors for Treatment of Alopecia Areata in the Military Health Care System.

Alopecia areata (AA) is a disease that manifests as patchy hair loss on the scalp and other parts of the body; severe disease may result in disfigurement, functional impairment, and significant psychological distress. This condition is understood to be caused by autoimmunity to the hair follicle and subsequent arrest of hair growth. New medications, baricitinib and ritlecitinib, belong to the Janus kinase (JAK) inhibitor family and are among the first FDA-approved treatments for severe AA. In this manuscript, we aim to answer the question: What treatment options exist for AA in the military health care system (MHS)? In doing so, we review the pathogenesis, physical and psychosocial impact of AA, conventional treatment of AA, and the efficacy and safety of baricitinib and ritlecitinib. A literature search was performed using PubMed, Embase, and Ovid for the history and pathogenesis of AA, psychosocial impact of disease, functional impairments, and current treatments. Keywords "alopecia areata," "current therapy for alopecia areata," "pathogenesis alopecia areata," "baricitinib," "ritlecitinib," "JAK inhibitor alopecia," "JAK inhibitor safety," "baricitinib efficacy," "alopecia eyelash," "alopecia nails," and "psychosocial impact of alopecia" were used for the search. The TRICARE manual was searched for guidelines applicable to the treatment of AA, DoD Instruction 6130.03 Volume 2 for medical standards for military service, and the U.S. Central Command Modification 15 for fitness of deployment to Central Command area of operations. Traditional treatments such as intralesional steroids may be effective for some patients, but difficulty lies in controlling extensive or refractory disease. Janus kinase inhibitors, baricitinib and ritlecitinib, are found effective at improving severe refractory disease; baricitinib induced hair regrowth in 32.6% more patients than placebo, and ritlecitinib was found to be superior to placebo by at least 24%. Currently, there is no coverage for therapeutic treatment of hair growth in the MHS. Additionally, military members are disqualified for continued service if they require immunomodulator medications such as baricitinib and ritlecitinib. Those on immunomodulators are unable to deploy worldwide. Baricitinib and ritlecitinib are effective treatments for widespread, progressive, and refractory AA. Although JAK inhibitors demonstrate improved effectiveness compared to non-immunomodulator treatments, their use in the MHS for this purpose is limited.

Patchy Hair Loss

ABSTRACT A 9-year-old boy was found to have new-onset hair loss on his scalp, which has worsened over the last 6 months. Readers will be asked to identify the correct diagnosis based on history and clinical presentation. The purpose of this case was to improve diagnostic skills to properly recognize this condition and provide the appropriate treatment.

Effect of minoxidil combined with triamcinolone acetonide on alopecia areata by microneedle injection.

Alopecia areata (AA) is often characterized by sudden onset of patchy hair loss. Topical corticosteroid injection is the most common treatment. This study retrospectively observed the clinical efficacy of microneedle minoxidil combined with triamcinolone acetonide in the treatment of AA. A total of 230 patients with AA were selected. The experimental group (n=120) received physician training and home microneedle treatment with minoxidil combined with triamcinolone acetonide once a week. Topical minoxidil and triamcinolone acetonide were used twice daily at other times. The control group (n=110) was treated with minoxidil combined with triamcinolone acetonide, twice a day. Cure rate, response rate, SALT, dermatological Quality of Life Index (DLQI), visual analogue (VAS), and cost were assessed at weeks 4 and 12. Treated group SALT score(Severity of Alopecia Tool)remarkable lower than control group after treated 4 and 12weeks. After 12weeks treatment, DLQI score of the treated group (1.8±1.67) were significantly lower than those of the control group (2.45±1.88) (p<0.05). VAS score and adverse reaction between two group showed no significant different (p=0.823, p=0.484 respectively). The total cost was 53.93±15.85 in the treatment group and 53.26±11.51 in the control group. There was no significant difference between the two groups (p=0.72). In the treated group, the complete response rate (CR: 78.33%) and total effective rate (CR+PR: 95%) were significantly higher than those in the control group (CR: 40.91% and CR+PR: 51.82%), with statistically significant differences (p<0.001). Microneedle introduction of minoxidil and triamcinolone acetonide in the treatment of AA is a safe, effective, economical, and convenient method, with few adverse reactions, and has a good application prospect.

Comparison of Efficacy of Topical Betamethasone Dipropionate and Topical Minoxidil in Patients With Alopecia Areata.

Background and objective Alopecia areata (AA) is a reiterative and nonscarring type of hair loss that can affect any hairy area of the body, particularly the scalp. It manifests as patchy or confluent hair loss with variations in demographics and ethnicity. There are numerous treatment options available, including topical and systemic steroids, topical minoxidil, dithranol, tacrolimus, psoralen and ultraviolet therapy (PUVA), contact immunotherapy, and oral immunosuppressive drugs. However, no previous contrast for efficacy is present between the topical betamethasone versus topical minoxidil alone in our population. This study aims to compare the efficacy of topical betamethasone dipropionate versus topical minoxidil in patients with AA. Methodology A nonrandomized controlled study was conducted at the Department of Dermatology, Jinnah Hospital Lahore, incorporating the data of patients between July 26, 2016, and January 26, 2017, after obtaining institutional ethical approval. One hundred patients with alopecia, either on the scalp or any other hairy part, from both genders, aged between 18 and 50 years, were included in the study. Two groups were created, and patients were assigned to these groups based on the clinician's choice. Group A patients were administered betamethasone dipropionate (0.05%) lotion twice daily on affected areas for 12 weeks. Group B patients were administered minoxidil (5%) solution twice daily on affected areas for 12 weeks. A four-week follow-up plan was followed. A five-point scale score system was used for alopecia grading. After 12 weeks, the hair regrowth score (RGS) was used to compare the efficacy of treatment between the two groups. Results A total of 100 patients with grades S1 to S3 AA of less than three months duration were enrolled. Two groups were created, with 50 patients in each group. The mean age in Group A was 29.08 ± 6.51 years, while in Group B, it was 29.38 ± 6.62 years. In Group A, there were 76% males and 24% females, while in Group B, there were 74% males and 26% females. Comparison of efficacy of topical betamethasone dipropionate versus topical minoxidil in patients with AA demonstrated a greater efficacy of 74% (Grade 3 and Grade 4 responses) in Group A, while in Group B, only 42% of patients showed efficacy. A statistically significant difference was found, with a P-value of 0.001. No serious side effects were noted. Conclusions Our study concluded that topical betamethasone dipropionate (0.05%) lotion has statistically significantly higher efficacy compared to topical minoxidil (5%) solution in patients with AA.

Parasurgical Management of Indralupta (Alopecia Areata) by Jalaukavcharana (Leech Therapy): A Case Report

Urdhwajatrugata Vyadhi (disease of the supra clavicular region) and Indralupta {Alopecia Areata (AA)} are characterised by patchy hair loss in the area that bears hair, such as the beard and scalp. According to Sushruta Acharya, vitiated pitta and vitiated vata together cause Indralupta (AA), leading to scalp hair loss. Additionally, vitiated Rakta and Kapha obstruct the hair follicles openings, limiting the growth of new hair. In contemporary science, these conditions are related to the clinical features of AA. A five-year-old female child presented to the Department of Kaumarbhritya with complaints of hair falling out in patches on the scalp gradually over six months. In her condition, the Raktamokshana therapy by using the jalaukavcharan vidhi technique was adopted for effective results. This age-old procedure described by Acharya Sushrut in Sushrut Samhita is still beneficial in treating the above aforementioned condition. The patient experienced relief from her symptoms after eight sessions and is continuing treatment. Raktamokshana, or therapeutic bloodletting, is one of the Ayurvedic therapy methods for Raktapradoshaja Vikara. Raktamokshana (Bloodletting) through leech treatment is one of the easiest methods to administer, especially for elderly patients, female patients, paediatric patients, individuals who are extremely shy, and those with sensitive constitutions like children. It resulted in fewer complications postprocedure and reduced the risk of symptom recurrence. The therapy was cost-effective, and within short span of three months, it produced positive outcomes in patients.

Management of Indralupta (Alopecia Areata) - A Case Study

Indralupta is one of the Urdhwajatrugata Vyadhi characterized by the patchy hair loss over hair-bearing skin that includes scalp and beard. According to Sushruta Acharya, Indralupta is due to the vitiated pitta in association with vitiated Vata causing the falling of hairs from the scalp and vitiated Rakta and Kapha block the orifices of the hair follicles which restricts the growth of new hair. Alopecia areata is autoimmune disease presented as nonscarring, circumscribed, smooth patch of hair loss, management is by the intralesional and topical corticosteroids. Shodhana (Raktamokshana) and Shamana Chikitsa is advised for the Indralupta in ayurveda classics. In this present case study 17 years old male patient is treated with Pracchanna Karma (Raktamokshana) followed by Maricha Lepa along with internal medicine. The therapy has shown a remarkable improvement in the signs of Indralupta. The patient obtained considerable relief from the symptoms through the therapy. The treatment proved to be easy, economical, highly effective with in short duration.

USE OF RITLECITINIB FOR THE TREATMENT OF ALOPECIA AREATA.

Dear Editor, Alopecia areata, an autoimmune condition, causes either patchy or complete hair loss from the body1 and occurs because the immune system attacks the hair follicles. It could present in severe forms as either alopecia totalis which is complete hair loss from the scalp or alopecia universalis which is hair loss from the whole body. Alopecia areata affects about 160 million people worldwide as reported by the National Alopecia Areata Foundation. Alopecia areata significantly affects the quality of life of the patients suffering from it as it is reported that the patients with alopecia areata were likely to have 30–38% increased chances of depression.2 A large number of research projects are underway to discover an effective treatment for this disease. In June 2023, the FDA approved Ritlecitinib (LITFULO) for the treatment of alopecia areata. Previously Baricitinib was discovered in June 2022 as a drug for alopecia areata but it was not safe to use in adolescents under 18. The benefit of Ritlecitinib over Baricitinib is that it can be used in young patients of 12 years of age and older. It is a significant discovery as many children suffer from this condition and are not willing to undergo invasive treatment options like intralesional steroids, platelet-rich plasma, and hair transplants. Ritlecitinib is a JAK3 and TEC inhibitor that acts by blocking the cytokines and T cells that are involved in causing the alopecia areata.3 This is supported by the randomised, double-blind ALLEGRO Phase 2b/3 trial in which patients who were treated with Ritlecitinib in a dose of 50 mg, once daily, for 24 weeks had 80% or more hair coverage of the scalp after six months of treatment compared to the placebo group.4 The most common side effects reported by Ritlecitinib are headache, upper respiratory tract infection, gastrointestinal upset, acne, folliculitis, dizziness, an increase in creatinine phosphokinase, and a decrease in red blood cell count.5 Ritlecitinib is a potential drug for the treatment of alopecia areata for those who are candidates for systemic therapy and has a lower side effect profile as it only blocks JAK3 as compared to other therapies which block JAK1/JAK2/all-JAK. Ritlecitinib would not only ease the treatment strategy for patients but will also help to reduce the chances of the side effects related to the invasive therapy like infection, bleeding, and scarring.

Practical Guideline for Prevention of Patchy Hair Loss following CyberKnife Stereotactic Radiosurgery for Calvarial or Scalp Tumors: Retrospective Analysis of a Single Institution Experience

Introduction: Patchy alopecia is a common adverse effect of stereotactic radiosurgery (SRS) on the calvarium and/or scalp, yet no guidelines exist for its prevention. This study aims to investigate the incidence and outcomes of patchy alopecia following SRS for patients with calvarial or scalp lesions and establish preventive guidelines. Methods: The study included 20 patients who underwent CyberKnife SRS for calvarial or scalp lesions, resulting in a total of 30 treated lesions. SRS was administered as a single fraction for 8 lesions and hypofractionated for 22 lesions. The median SRS target volume was 9.85 cc (range: 0.81–110.7 cc), and the median prescription dose was 27 Gy (range: 16–40 Gy), delivered in 1–5 fractions (median: 3). The median follow-up was 15 months. Results: Among the 30 treated lesions, 11 led to patchy alopecia, while 19 did not. All cases of alopecia resolved within 12 months, and no patients experienced other adverse radiation effects. Lesions resulting in alopecia exhibited significantly higher biologically effective dose (BED) and single-fraction equivalent dose (SFED) on the overlying scalp compared to those without alopecia. Patients with BED and SFED exceeding 60 Gy and 20 Gy, respectively, were 9.3 times more likely to experience patchy alopecia than those with lower doses. The 1-year local tumor control rate for the treated lesions was 93.3%. Chemotherapy was administered for 26 lesions, with 11 lesions receiving radiosensitizing agents. However, no statistically significant difference was found. Conclusion: In summary, SRS is a safe and effective treatment for patients with calvarial/scalp masses regarding patchy alopecia near the treated area. Limiting the BED under 60 Gy and SFED under 20 Gy for the overlying scalp can help prevent patchy alopecia during SRS treatment of the calvarial/scalp mass. Clinicians can use this information to inform patients about the risk of alopecia and the contributing factors.

Diagnostic dilemma: Multiple Autoimmune Syndrome versus incomplete Graham-Little-Piccardi-Lassueur Syndrome overlap mixed connective tissue disease

Objectives. We present a very rare case of incomplete Graham-Little-Piccardi-Lassueur syndrome (GLPLS) overlap with Mixed Connective Tissue Disease (MCTD) versus Multiple Autoimmune Syndrome (MAS). Case Presentation. A 53- year-old female with a long history of more than two years of patchy hair loss on scalp like “footprints in the snow”, partial loss of eyebrows' hair, face erythema, scaly atrophied red/brown patches on face, grouped follicular papules 2-3 mm in diameter with a pointed or hair-like horny spine extending approximately 1-2 mm around the tip of the follicle on lumbar area. The histopathological results from biopsies of scalp and lumbar areas confirmed the clinical diagnosis of cicatricial alopecia induced by lichen plan pilaris (LPP) and also presence of lichen spinulosus (LS) on lumbar area. The description provided by pathologist is however borderline regarding so called interface dermatosis like chronic cutaneous lupus erythematous (CCLE) or Pseudopelade of Brocq (PPB) as the end stage of CCLE or LPP. Blood tests showed both Antinuclear antibodies and U1-nRNP in high titers and the absence of anti-Sm, anti SS-A, anti SS-B and anti-dsDNA antibodies, and also peculiar antibody patterns of MCTD. Outcome. After thorough investigation, MCTD was proven by antibodies results. After one year of treatment a lot of clinical features dramatically responded under therapy. Conclusions. Clinical manifestations in the pathology with strictly cutaneous or systemic localization in conjunction or overlap with other autoimmune diseases (grouped in the MAS) represent a rare diagnostic in daily practice.

PA32 Severe lichen planus with co-localization of vitiligo: a rare and unusual case

Abstract A 13-year-old boy was seen in the urology clinic for hypo­pigmented patches on the glans penis. He underwent circumcision for presumed balanitis xerotica obliterans, but histological examination of the skin showed lichen planus (LP). This prompted a full skin check by the team, which showed similar patches on the scrotum, anus and ears. A referral was made to dermatology for further assessment. Closer history revealed a 1-year history of inflamed patches behind the ears that spread to the periorbital and penile regions. Concurrent patchy hair loss was noted over this time period; otherwise, he was asymptomatic, with no relevant past medical or family history. Full skin check revealed extensive areas of well-circumscribed erythema on the penis, peri-orbitally and within the conchal bowl of both ears. Areas of scarring alopecia were present with complete loss of the eyelashes. The severity of his condition warranted the immediate commencement of high-dose oral steroid therapy and a trial of protopic 0.1% ointment. A review 6 months later showed no further erythema but areas of clearly defined depigmentation where there was previously active LP, particularly across the nose and periorbitally, consistent with vitiligo. Ongoing follow-up at 1 year showed the stable appearance of these areas, despite ongoing use of topical calcineurin inhibitor. Co-localization of vitiligo in the context of LP is a rare entity, noted in only 10 case reports in the literature. The fact that both LP and vitiligo are common, each said to affect 1–2% of the general population, may mean that their association is merely a coincidence. However, a number of publications suggest that a causal link must be present as similar immunological mechanisms are shared by the two conditions. The aetiology of both LP and vitiligo is known. Various theories exist, including the autoimmune hypothesis, as both conditions are immunologically mediated. Another assumes inflammatory mediator release from ultraviolet damage, particularly on areas of photosensitive depigmented skin. A third supposes that photodamage induces Koebner phenomenon on vitiligo-affected skin, resulting in LP on these areas. No theory has been proven definitively. In most cases, vitiligo is described as the precursor disease; rarely, both diseases occur concomitantly and progress together. We present a rare case of LP preceding vitiligo. Our case not only demonstrates the importance of a full skin examination in diagnosing lesions, but provides further evidence that this association is more than coincidental. More studies into these conditions are needed to understand this phenomenon in its entirety.

Selamectin Spot-on: A Cure for Scabies in Rabbits

Introduction: Mange in rabbits is a highly contagious zoonotic disease. The disease is caused mainly by Sarcoptes scabiei, Psoroptes cuniculi, Cheyletiella parasitovorax, and Notoedres cati. The most common forms of this disease in rabbits are body and ear mange. Mites infest animals through direct contact with infected animals or contaminated. Case report: An 8-month-old non-descript female rabbit weighing about 700 g was presented to the Teaching Veterinary clinical complex, Mettupalayam, Puducherry, India, with a history of scratching, pruritus and dried crusty lesions on the margins of the ears, snout, around the eyes and legs and patchy hair loss for the past 15 days. Rectal temperature was 38.4°C, heart rate was 210 bpm, respiratory rate was 40 breaths/minute, and the color of the conjunctival mucous membrane was pink. Other signs included inappetence with normal voiding habits and a thin body condition. The collected skin scraping from the affected areas was examined under the microscope with a 10x objective lens, confirming the presence of live motile Sarcoptes spp. Mite species could be determined through the morphological characteristics (adult mites are nearly circular with short legs, and the third and fourth pairs do not project beyond the margin of the body with terminal anus) under the microscopic examination of the skin scrapings. Therefore, 6% selamectin was applied topically on a single spot at the base of the neck. Supportive therapy with multivitamin (vitamin A, D3, E, B12) drops was given orally at 1 ml per day. Conclusion: The rabbit responded well to the treatments within 2 weeks.

Effect of Ayurveda Treatment in the Management of Indralupta w.s.r. Tinea Capitis: A Case Study

Hairs play an important role in making body externally beautiful, mentally enthusiastic and healthy. Hair loss is common clinical complaint due to pollution, unhealthy diet, physical or emotional stress, poor hygiene and infection. Patchy hair loss considered as Alopecia. Tinea capitis is irregular patchy hair loss due to infection. In Ayurveda hair loss considered as Indralupta. Aim: To study the concept of Ayurvedic treatment in respect to Indralupta. Material and Methods: A Female child age 10 years suffering from multiple patches of hair loss over the scalp. Itching, Redness, Slight local pain during combing scaly patches that may blister and ooze has been reported. It was treated with Ayurvedic medicine both Internal and external for a period of 2 month. Result: After 15 days associated symptoms (itching, redness, inflammation, blister) was reduced. After 1 month the patient was examined for presence of hair follicles and growth of hair over affected area. Conclusion: The given Ayurvedic treatment was successful in treating the Indralupta.

EPH39 Alopecia Areata: Targeted Review of Adverse Events Associated with Clinical Studies of Treatments

Alopecia areata (AA) is a common autoimmune disease characterized by sudden patchy hair loss. Although a few treatments have been reported to have a beneficial effect, assessment of adverse events (AEs) in clinically controlled studies remains insufficiently established, thereby compromising the safety profiles of treatments. This targeted review aimed to quantify the most frequently reported AEs in clinical studies, including phase II, III, randomized controlled trials, and other prospective randomized studies for the treatment of AA.

Comparison of Intra-lesional Methotrexate and Intra-lesional Triamcinolone Acteonid in the treatment of Localized Alopecia Areata

Background: One of the common reasons of non-scarring, patchy or confluent hair loss that can affect any part of the body, but most frequently the scalp, is alopecia areata. Alopecia areata (AA) has a variety of therapy options, but it is still a difficult condition with varied severity, recurrence, and a significant cosmetic problem. Aim: To compare the effects of intralesional triamcinolone acetate and intralesional metatrexate in the treatment of localized alopecia areata in patients at the dermatology department. Study design: Comparative clinical study. Methodology: The dermatology division of Sheikh Zayed Hospital Rahim Yar Khan conducted the current study. The current study included 128 participants. Each chosen group included 64 patients. The sample size was calculated assuming a research power of 80%, a confidence level of 95%, and an efficacy of 60.0% for methotrexate and 80.0% for triamcinolone. Using a 30-gauge needle connected to an insulin syringe, both groups will get intralesional injections in patches with alopecia areata three weeks apart for a maximum of four sessions. A follow-up will be conducted a year following the end of the treatment. The analysis of the data was done using SPSS 23. Chi-square/exact Fisher's tests were performed to examine the gender distribution, results, respondents, and recurrence rate between the two groups with a p-value of less than 0.05. Results: Patients in group A had an average age of 29.2 +/-3.8 years, whereas those in group B had an average age of 30.0 +/-2.1 years. There was no discernible difference in the mean age of the patients between the two groups, according to an independent sample t test (p = 0.178). The gender distribution between the two groups is not significantly different, according to the p-value of 0.857. The p-value of 0.115 shows that there was no discernible difference in the two groups' rates of remission. The p-value of 0.188 shows that the two groups' recurrence rates did not differ significantly from one another. Practical Implication: This study helped researchers investigate the efficacy of intra-lesional triamcinolone acetonide as a treatment for localized alopecia areata due to its accessibility and safety. Second, it added to the corpus of information in the field regarding alternative, successful treatment options that are comparable. Conclusion: It was determined that there was no statistically significant difference between the outcomes for the Triamcinolone group and the Methotrexate group. Keywords: Alopecia Areata, Efficacy, Intralesional Methotrexate, Triamcinolone Acetonide and Clinical Outcomes.