Comparison of Safety and Efficacy of Topical Mometasone 0.1% Ointment, Calcipotriol 0.005% Ointment, and Tacrolimus 0.1% Ointment in Patients with Localized Alopecia Areata: A Triple-Arm Randomized Clinical Study.

Background: Alopecia areata (AA) is an autoimmune, T-cell-mediated disorder manifesting as non-scarring alopecia. Treatment consists of corticosteroids, calcineurin inhibitors, prostaglandin analogs, minoxidil, anthralin, vitamin D analogs, and JAK STAT inhibitors. Despite several treatment options, personal opinions regarding the safety and efficacy of a particular treatment are highly variable. This has led the management of AA to be quite challenging.

Aim: To compare the efficacy and safety between the three molecules, namely mometasone 0.1% ointment, calcipotriol 0.005% ointment, and tacrolimus 0.1% ointment, in localized AA.

Patients and methods: Patients were randomized into three groups, and topical medications were dispensed for each group in unlabeled tubes. Lesional photographs, dermoscopic images, Severity of Alopecia Tool (SALT) scoring, hair pull test, and Dermatology Life Quality Index questionnaires were done at the baseline visit and at every follow-up visit at 4 weeks and 8 weeks from the baseline visit.

Results: At the end of 8 weeks, both mometasone and calcipotriol groups had a significant decrease in their SALT scores (<0.001), but the tacrolimus group did not show any significant change in parameters at the end of the study.

Limitations: The main drawback is that there was no control group and the vehicle dispensed was ointment formulation, which may have penetration issues. The lack of long-term follow-up is also a limitation of this study.

Conclusion: Both mometasone and calcipotriol formulations were found to be effective in the treatment of localized stable AA; however, calcipotriol preparation was associated with minimal side effects.