Microneedling vs Injectable Steroids for Alopecia areata: How do they Compare?

Microneedling vs Injectable Steroids: how do they compare?

When COVID lockdowns first appeared in march April 2020, I heard of patients that normally get steroid injections at a dermatologist’s office being told to just buy a microneedling device and apply steroids at home and microneedle the skin.  My thought was “what a great idea!” Lockdowns cleared and patients returned to clinic.  I never came to know how great of an idea this really was

A new study now set out to compare microneedling with injections. There were two groups in the study. Patients in Group 1 underwent microneedling with a 1.5 mm microneedle with topical application of injectable triamcinolone before the dermarolling and again after the dermarolling. Half the dose was injected before and half was injected after.  Dermarolling was done on the scalp patches diagonally, vertically, and horizontally 4–5 times in each direction.

Group 2 had the steroid injected.  The dose used was 10 mg/ml and the total volume was 0.1 ml/cm2 area.  Patients had three sessions three week apart.

The mean age of onset of disease in all the patients was 27.35 ± 8.48 years and was comparable in two study groups (Group 1 – 28.93 ± 9.436; Group 2 – 25.77 ± 7.229). The duration of disease ranged between 1 and 64 weeks, with a mean duration of 13.27 ± 15.5 weeks.

Mean area of lesions at week 0 was 13.87 cm2 in Group 1 and 10.20 cm2 in Group 2

Overall, in Group 1, a mean regrowth of 66.36% occurred at week 9. Similarly, in Group 2, this was 69.75% at week 9. Subsequently, the regrowth was comparative with the treatment methods with no significant statistical difference between the two groups at week 9 (P = 0.664)  Thirteen patients achieved 100% regrowth at week 9 in Group 1 and 16 patients achieved 50%–99% regrowth in Group 2   

The authors protocol comes from a 2014 paper published in the Journal of Cutaneous and Aesthetic surgery titled  Alopecia Areata—Successful Outcome with Microneedling and Triamcinolone Acetonide. In this paper, the authors described two patients with alopecia areata who have no improvement with intralesional injections of triamcinolone acetonide, topical steroid creams, and minoxidil 5% lotion but with no improvement.

They then underwent the following dermarolling protocol.

 The protocol involved treatment with microneedling using a derma roller having 192 needles of 1.5-mm length each followed by topical application of triamcinolone acetonide. Triamcinolone acetonide in concentration of 10 mg/ml (0.1 ml containing 1 mg of triamcinolone) was applied on each lesion twice, before and after performing dermaroller. Under aseptic precautions, the dermaroller was moved on the scalp patches diagonally, vertically and horizontally 4 to 5 times in each direction after applying triamcinolone acetonide. This created pin point bleeding which was taken as an end point, following which triamcinolone was applied topically. No anaesthesia was used as the procedure was relatively painless. Three sessions were done every 3 week intervals.

Conclusions

The data from 2014 and the new 2022 data by Arora A et al is interesting. It suggests that microneedling with topical triamcinolone is a potentially helpful method of treating alopecia areata. What’s so fascinating here is how painless the authors say this is.

One wonders if and how this can be incorporated with topical clobetasol and whether other strategies can be employed for home use - under supervision from a doctor.

REFERENCES

Arora A et al. Comparative Efficacy of Injection Triamcinolone Acetonide given Intralesionally and through Microneedling in Alopecia areata. Int J Trichology. 2022 Sep-Oct;14(5):156-161.

Chandrashekar BS et al. Alopecia areata-successful outcome with microneedling and triamcinolone acetonide. J Cutan Aesthet Surg. 2014 Jan;7(1):63-4.