Corticosteroid Injections and Alopecia
Yes, corticosteroid injections can both treat and cause alopecia, depending on the context and application. 1, 2
Corticosteroid Injections for Treating Alopecia Areata
- Intralesional corticosteroid injections are the first-line treatment for limited patchy hair loss in alopecia areata 2, 3
- Triamcinolone acetonide (5-10 mg/mL) is commonly used, with success rates of up to 62% reported with monthly injections 4, 3
- Injections of 0.05-0.1 mL per site can produce a tuft of hair growth about 0.5 cm in diameter 2, 4
- The effect typically lasts about 9 months, with tufts of hair growing in 33 of 34 sites injected with triamcinolone hexacetonide and in 16 of 25 sites injected with triamcinolone acetonide 2, 4
- Methylprednisolone acetate is FDA-approved for intralesional use in alopecia areata 1
Side Effects of Corticosteroid Injections Including Alopecia
- Skin atrophy at the injection site is a consistent side effect of intralesional corticosteroids, particularly with triamcinolone 4, 3
- Localized alopecia can occur at injection sites due to skin atrophy and disruption of hair follicles 4
- Other local adverse effects may include pigmentary changes, telangiectasias, and hypertrichosis 5
- Dermoscopy can identify adverse effects earlier than clinical examination 6
Best Candidates for Intralesional Corticosteroid Treatment
- Most suitable for patients with fewer than five patches of hair loss, each less than 3 cm in diameter 4, 3
- Better response rates in localized alopecia compared to extensive hair loss 4, 7
- Less effective in alopecia totalis or universalis patterns 8
- Multiple injections may be given, with the main limitation being patient discomfort 2
Alternative Approaches for Extensive Alopecia
- Contact immunotherapy (diphenylcyclopropenone) is recommended as first-line treatment for extensive patchy hair loss 3
- Systemic corticosteroids may be considered for severe cases but are not routinely recommended due to potential serious side effects 3, 9, 10
- No treatment is a legitimate option for many patients, especially those with limited disease of short duration (<1 year), as spontaneous remission occurs in up to 80% of such cases 2, 3
Clinical Pearls and Pitfalls
- Intralesional corticosteroids should be injected just beneath the dermis in the upper subcutis for optimal effect 2, 4
- Needleless devices (e.g., Dermajet) can be used as an alternative administration method 2, 4
- Folliculitis is a common side effect of treatment with potent topical steroids 2
- Relapse following treatment discontinuation is common, particularly with systemic corticosteroid therapy 9, 10
- Dermoscopy can be used to monitor treatment response, with new vellus hair growth often visible at 4 weeks 6