Comparison of clinical efficacy and trichoscopic changes in alopecia areata of the scalp following treatment with intralesional triamcinolone acetonide and autologous platelet-rich plasma

Background: Alopecia areata (AA) is an autoimmune disease affecting the scalp and body, resulting in hair loss. The fundamental goal of management is to keep the pathology under control. Intralesional corticosteroids suppress T-cell-mediated attacks on hair follicles. Platelet-rich plasma (PRP) contains growth factors that stimulate hair follicle stem cells and have anti-inflammatory properties with fewer side effects. Trichoscopy shows exclamation hair and black dots in the acute stage, yellow dots in long-standing cases, and short vellus hair in regrowing patches. Objective: The aim of this study was to evaluate and compare the efficacy of intralesional triamcinolone acetonide with autologous PRP in the treatment of two different scalp AA patches in the same individual. Materials and Methods: This was a hospital-based prospective follow-up study. Patients with two different patches of alopecia were selected. One was treated with intralesional triamcinolone acetonide (10 mg/ml) and the other with PRP given at 3-week intervals for four treatment sessions. Comparison of results was based on MacDonald Hull and Norris grading system and trichoscopy. Results: Out of 32 patients, 8 (25%) in triamcinolone-treated patches and 3 (9.4%) in PRP-treated patches showed complete hair regrowth at 12 weeks. Furthermore, a faster response was seen with triamcinolone. On trichoscopy, both patches showed an increase in short vellus and terminal hair and a reduction in yellow dots and exclamation hair. No changes in black dots were seen. Conclusion: Intralesional triamcinolone acetonide is more effective than PRP in the treatment of AA of the scalp and is safe. Trichoscopic findings indicate response to treatment and reduction of disease activity.