Intralesional Steroids for Androgenic Alopecia
No, intralesional steroids do not help treat androgenic alopecia and should not be used for this condition. Intralesional corticosteroids are specifically indicated for alopecia areata, not androgenic (hormonal) alopecia, which is an entirely different disease process requiring different treatment approaches.
Critical Distinction Between Hair Loss Types
You are asking about the wrong condition. The evidence provided exclusively addresses alopecia areata (an autoimmune condition causing patchy hair loss), not androgenic alopecia (genetic/hormonal pattern baldness) 1, 2, 3. These are fundamentally different diseases:
- Alopecia areata: Autoimmune attack on hair follicles causing round/oval patches of complete hair loss with preserved follicles 2
- Androgenic alopecia: Hormonal miniaturization of hair follicles causing diffuse thinning in a pattern distribution (male or female pattern baldness)
Why Intralesional Steroids Work for Alopecia Areata (Not Androgenic Alopecia)
Intralesional triamcinolone acetonide is first-line treatment specifically for alopecia areata with limited patchy involvement 2, 3:
- Achieves 62% full regrowth rates in patients with fewer than five patches less than 3 cm in diameter 2, 3
- Recommended dosing: triamcinolone acetonide 5-10 mg/mL injected monthly until satisfactory response 3
- Success rates of 60% (6 out of 10 patients) even in extensive alopecia areata (>50% scalp involvement) 4
Mechanism Mismatch
The therapeutic mechanism of corticosteroids addresses autoimmune inflammation in alopecia areata 1, 3, which is irrelevant to androgenic alopecia where the pathophysiology involves:
- Dihydrotestosterone (DHT) sensitivity of hair follicles
- Progressive follicular miniaturization
- No inflammatory or autoimmune component
Appropriate Treatments for Androgenic Alopecia
For androgenic alopecia, evidence-based treatments include:
- Topical minoxidil (though notably ineffective as monotherapy for alopecia areata) 3
- Oral finasteride or dutasteride (5-alpha reductase inhibitors)
- Topical antiandrogens
- Hair transplantation
None of these involve intralesional corticosteroids.
Common Pitfall to Avoid
Do not confuse different types of hair loss. Using intralesional steroids for androgenic alopecia would be:
- Ineffective (wrong mechanism of action)
- Potentially harmful (unnecessary steroid exposure with risk of skin atrophy) 3
- A waste of resources and patient time
The only scenario where steroids and hair loss intersect in androgenic alopecia is that systemic corticosteroids can actually cause hair loss as an adverse effect 5, making their use even more inappropriate for this condition.