Abstract
BACKGROUND: Alopecia areata (AA) is a common autoimmune disease characterized by non-scarring hair loss. The disease occurs in both sexes, with no racial or age-related predilection. Many patients experience spontaneous improvement and regrowth of hair, while some patients are resistant to common therapies and others progress to more severe forms of alopecia. The primary treatment for patchy and limited alopecia of the scalp and face is intralesional triamcinolone injection. Previous studies have also reported the efficacy of cryotherapy (liquid nitrogen), which promotes hair regrowth through mechanisms such as local vasodilation and targeting keratinocyte antigens. AIMS: Since both modalities have been used independently, we aimed to evaluate the synergistic effect of both treatments in combination and compare it with triamcinolone injection alone. METHODS: In this prospective, randomized, within-subject controlled trial, 22 participants with limited patchy alopecia affecting the scalp and face were enrolled. Each patient had symmetrical patches randomly assigned to two treatment modalities: one side received a combination of cryotherapy followed by an intralesional injection of triamcinolone acetonide (8 mg/mL for scalp and 4 mg/mL for face), while the contralateral side received intralesional triamcinolone acetonide alone. Treatments were administered in four consecutive sessions at 4-week intervals. The primary outcome was the assessment of hair loss severity using the Severity of Alopecia Tool (SALT) score for the scalp and the ALBAS score for the facial area, measured at each visit. Adverse events were evaluated throughout the treatment period. RESULTS: Both treatment methods demonstrated a statistically significant difference in within-group analysis (p < 0.001). However, a comparison of the two treatments did not reveal any statistically significant superiority between the methods (p > 0.05). Additionally, no major adverse effects were observed. CONCLUSION: This study demonstrated that both combination therapy and triamcinolone injection are equally effective in treating alopecia. However, future research with a larger sample size, extended follow-up, and comparisons of trichoscopic findings is warranted.