Comparison of the Efficacy of Topical Methotrexate 1% gel Versus Topical Betamethasone Dipropionate 0.05% Lotion in the Treatment of Localized Scalp Alopecia Areata in a Tertiary Care Institute of Central India: A Randomized Control Trial.

Background: The first line of therapy for limited patchy alopecia areata is topical corticosteroids. Recently, topical methotrexate has been found effective in alopecia areata.

Objective: To compare the efficacy between topical methotrexate and betamethasone dipropionate lotion in the treatment of localized scalp alopecia areata.

Patients and methods: Seventy patients with localized scalp alopecia areata were randomized by block randomization in a 1:1 ratio to two groups. Group A received methotrexate 1% gel twice daily, and group B received betamethasone dipropionate 0.05% lotion twice daily for 12 weeks or until a hair regrowth score of 5 was achieved.

Results: Fifty-six patients completed the trial. In the per-protocol analysis, no significant difference was seen in the decrease in severity of alopecia tool (SALT) score between group A and group B. The median (25 th -75 th percentile) modified hair regrowth scale at 4 weeks and 12 weeks in group A was 1 (0-2) and 4 (3.5-5), respectively. In group B, it was 1 (0-1.5) and 4 (3-5), respectively, with no significant difference between them. Mild and tolerable side effects were seen in both groups. Irritant dermatitis was seen in 31.03% of patients in group A. Itching was reported in 16 patients in group A as compared to 4 patients in group B, which was statistically significant ( P value = 0.002).

Limitations: Few patients were lost to follow-up and patients were not followed up after stopping treatment to assess the long-term treatment response or relapse.

Conclusion: Both methotrexate gel and betamethasone lotion are effective and safe treatments for localized alopecia areata, showing comparable overall response rates. However, local side effects are more common with methotrexate gel than with betamethasone lotion. This study suggests that methotrexate gel can be considered one of the topical treatment options for localized alopecia areata.