{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T15:58:34Z","timestamp":1785513514238,"version":"3.56.0"},"reference-count":22,"publisher":"Mattioli1885","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction: Alopecia areata (AA) is a chronic, immune\u2011mediated, non\u2011scarring hair loss disorder. While intralesional corticosteroids remain first\u2011line treatment, some patients with recalcitrant AA respond poorly. Microneedling enhances transdermal drug delivery via microchannel formation. Methotrexate, an established systemic immunomodulator, is effective in resistant AA but has been less extensively studied for topical administration. Objectives: To compare the efficacy and safety of methotrexate and triamcinolone acetonide, both delivered via microneedling, in recalcitrant AA. Methods: In this prospective, intra\u2011individual comparative study, 34 patients with at least two patches of recalcitrant AA received microneedling followed by topical methotrexate (25\u202fmg\/mL) on one site and triamcinolone acetonide (5\u202fmg\/mL) on a matched site, administered fortnightly for 12\u202fweeks. The primary outcome was the change in Severity of Alopecia Tool (SALT) score. Secondary outcomes included trichoscopic assessment, blinded photographic evaluation, patient satisfaction, and relapse rates at three\u2011month follow\u2011up. Safety was assessed at each visit. Results: Both treatment modalities were associated with overall clinical improvement. Methotrexate\u2011treated areas showed significantly greater reductions in SALT scores (P&lt;0.05), higher levels of patient satisfaction, and lower relapse rates at follow\u2011up compared to triamcinolone\u2011treated areas. Both modalities were well tolerated, with only mild, transient adverse effects reported. Conclusions: In this pilot intra-individual study, microneedling-assisted methotrexate appeared to provide superior short-term clinical outcomes to triamcinolone acetonide with an acceptable safety profile in recalcitrant AA. These findings warrant confirmation in larger, adequately powered controlled trials with 6\u201312-month follow-up to evaluate durability, relapse, and long-term safety.<\/jats:p>","DOI":"10.5826\/dpc.1603a6805","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T15:08:07Z","timestamp":1785510487000},"page":"6805","source":"Crossref","is-referenced-by-count":0,"title":["Intra-Individual Comparative Study of Methotrexate versus Triamcinolone Acetonide Delivered via Microneedling for Recalcitrant Alopecia Areata"],"prefix":"10.5826","volume":"16","author":[{"given":"Mofreh","family":"Mansour","sequence":"first","affiliation":[{"name":"Department of Dermatology, Faculty of Medicine for Girls, Al-Azhar University, New Damietta, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Refaat","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athar","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6212-9748","authenticated-orcid":false,"given":"Mahmoud","family":"Rageh","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"27750","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"10.5826\/dpc.1603a6805_ref1","doi-asserted-by":"crossref","unstructured":"Mirzoyev SA, Schrum AG, Davis MDP, Torgerson RR. Lifetime incidence risk of alopecia areata estimated at 2.1% by Rochester Epidemiology Project, 1990-2009. J Invest Dermatol. 2014;134(4):1141-1142. DOI:10.1038\/jid.2013.464","DOI":"10.1038\/jid.2013.464"},{"key":"10.5826\/dpc.1603a6805_ref2","doi-asserted-by":"crossref","unstructured":"Rajabi F, Drake LA, Senna MM, Rezaei N. Alopecia areata: a review of disease pathogenesis. Br J Dermatol. 2018;179(5):1033-1048. DOI:10.1111\/bjd.16808","DOI":"10.1111\/bjd.16808"},{"key":"10.5826\/dpc.1603a6805_ref3","doi-asserted-by":"crossref","unstructured":"Zhou C, Li X, Wang C, Zhang J. Alopecia Areata: an Update on Etiopathogenesis, Diagnosis, and Management. Clin Rev Allergy Immunol. 2021;61(3):403-423. DOI:10.1007\/s12016-021-08883-0","DOI":"10.1007\/s12016-021-08883-0"},{"key":"10.5826\/dpc.1603a6805_ref4","doi-asserted-by":"crossref","unstructured":"Phan K, Ramachandran V, Sebaratnam DF. Methotrexate for alopecia areata: A systematic review and meta-analysis. J Am Acad Dermatol. 2019;80(1):120-127.e2. DOI:10.1016\/j.jaad.2018.06.064","DOI":"10.1016\/j.jaad.2018.06.064"},{"key":"10.5826\/dpc.1603a6805_ref5","doi-asserted-by":"crossref","unstructured":"Jaiswal S, Jawade S. Microneedling in Dermatology: A Comprehensive Review of Applications, Techniques, and Outcomes. Cureus. 2024;16(9):e70033. Published 2024 Sep 23. DOI:10.7759\/cureus.70033","DOI":"10.7759\/cureus.70033"},{"key":"10.5826\/dpc.1603a6805_ref6","doi-asserted-by":"crossref","unstructured":"Rodr\u00edguez-Villa Lario A, Aguado-Garc\u00eda \u00c1, Andr\u00e9s-Lencina JJ, et al. Successful Response to a Combination of Intralesional Methotrexate and Fractional CO2 Laser in Refractory Alopecia Areata: Case Report. Skin Appendage Disord. 2022;8(6):486-491. DOI:10.1159\/000524672","DOI":"10.1159\/000524672"},{"key":"10.5826\/dpc.1603a6805_ref7","doi-asserted-by":"crossref","unstructured":"Olsen EA, Hordinsky MK, Price VH, et al. Alopecia areata investigational assessment guidelines--Part II. National Alopecia Areata Foundation. J Am Acad Dermatol. 2004;51(3):440-447. DOI:10.1016\/j.jaad.2003.09.032","DOI":"10.1016\/j.jaad.2003.09.032"},{"key":"10.5826\/dpc.1603a6805_ref8","doi-asserted-by":"crossref","unstructured":"Lim SK, Lim CA, Kwon IS, et al. Low-Dose Systemic Methotrexate Therapy for Recalcitrant Alopecia Areata. Ann Dermatol. 2017;29(3):263-267. DOI:10.5021\/ad.2017.29.3.263","DOI":"10.5021\/ad.2017.29.3.263"},{"key":"10.5826\/dpc.1603a6805_ref9","doi-asserted-by":"crossref","unstructured":"Arora A, Bhalla M, Thami GP. Comparative Efficacy of Injection Triamcinolone Acetonide given Intralesionally and through Microneedling in Alopecia areata. Int J Trichology. 2022;14(5):156-161. DOI:10.4103\/ijt.ijt_140_20","DOI":"10.4103\/ijt.ijt_140_20"},{"key":"10.5826\/dpc.1603a6805_ref10","doi-asserted-by":"crossref","unstructured":"Al-Dhubaibi MS, Alsenaid A, Alhetheli G, Abd Elneam AI. Trichoscopy pattern in alopecia areata: A systematic review and meta-analysis. Skin Res Technol. 2023;29(6):e13378. DOI:10.1111\/srt.13378","DOI":"10.1111\/srt.13378"},{"key":"10.5826\/dpc.1603a6805_ref11","doi-asserted-by":"crossref","unstructured":"El Mulla KF, Elmorsy EH, Halwag DI, Hassan EM. Transepidermal Delivery of Triamcinolone Acetonide or Platelet Rich Plasma Using Either Fractional Carbon Dioxide Laser or Micro-needling in Treatment of Alopecia Areata. Dermatol Pract Concept. 2022;12(4):e2022196. DOI:10.5826\/dpc.1204a196","DOI":"10.5826\/dpc.1204a196"},{"key":"10.5826\/dpc.1603a6805_ref12","doi-asserted-by":"crossref","unstructured":"Ageeba B, Zaki A, Elrewiny E. Microneedling with Triamcinolone acetonide versus Intralesional Triamcinolone acetonide in treatment of Alopecia Areata. Al-Azhar International Medical Journal. 2023;2023(2):233-239. DOI: 10.21608\/aimj.2025.156611.2088","DOI":"10.21608\/aimj.2025.156611.2088"},{"key":"10.5826\/dpc.1603a6805_ref13","doi-asserted-by":"crossref","unstructured":"Hull SM, Norris JF. Diphencyprone in the treatment of long-standing alopecia areata. Br J Dermatol. 1988;119(3):367-374. DOI:10.1111\/j.1365-2133.1988.tb03230.x","DOI":"10.1111\/j.1365-2133.1988.tb03230.x"},{"key":"10.5826\/dpc.1603a6805_ref14","doi-asserted-by":"crossref","unstructured":"Strazzulla LC, Wang EHC, Avila L, et al. Alopecia areata: An appraisal of new treatment approaches and overview of current therapies. J Am Acad Dermatol. 2018;78(1):15-24. DOI:10.1016\/j.jaad.2017.04.1142","DOI":"10.1016\/j.jaad.2017.04.1142"},{"key":"10.5826\/dpc.1603a6805_ref15","doi-asserted-by":"crossref","unstructured":"Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006;54(1):1-18. DOI:10.1016\/j.jaad.2005.01.010","DOI":"10.1016\/j.jaad.2005.01.010"},{"key":"10.5826\/dpc.1603a6805_ref16","doi-asserted-by":"crossref","unstructured":"Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update: part II. Treatment. J Am Acad Dermatol. 2010;62(2):191-204. DOI:10.1016\/j.jaad.2009.10.031","DOI":"10.1016\/j.jaad.2009.10.031"},{"key":"10.5826\/dpc.1603a6805_ref17","doi-asserted-by":"crossref","unstructured":"Rajan M B, Bhardwaj A, Singh S, et al. Identification of novel step-up regimen of intralesional triamcinolone acetonide in scalp alopecia areata based on a double-blind randomized controlled trial. Dermatol Ther. 2021;34(1):e14555. DOI:10.1111\/dth.14555","DOI":"10.1111\/dth.14555"},{"key":"10.5826\/dpc.1603a6805_ref18","unstructured":"Abdo HM, Elrewiny EM, Shawky A, Ammar AM, Atef AM, Rageh MA. Intralesional Pentoxifylline Injection Versus Triamcinolone Acetonide in Treating localized Alopecia Areata: A Comparative Study. J Clin Aesthet Dermatol. 2023;16(11):26-30."},{"key":"10.5826\/dpc.1603a6805_ref19","doi-asserted-by":"crossref","unstructured":"Hamdino M, El-Barbary RA, Darwish HM. Intralesional methotrexate versus triamcinolone acetonide for localized alopecia areata treatment: A randomized clinical trial. J Cosmet Dermatol. 2022;21(2):707-715. DOI:10.1111\/jocd.14090","DOI":"10.1111\/jocd.14090"},{"key":"10.5826\/dpc.1603a6805_ref20","doi-asserted-by":"crossref","unstructured":"Katoulis AC, Pappa G, Sgouros D, et al. A Three-Step Diagnostic Algorithm for Alopecia: Pattern Analysis in Trichoscopy. J Clin Med. 2025;14(4):1195. Published 2025 Feb 12. DOI:10.3390\/jcm14041195","DOI":"10.3390\/jcm14041195"},{"key":"10.5826\/dpc.1603a6805_ref21","doi-asserted-by":"crossref","unstructured":"Dainichi T, Kabashima K. Alopecia areata: What's new in epidemiology, pathogenesis, diagnosis, and therapeutic options?. J Dermatol Sci. 2017;86(1):3-12. DOI:10.1016\/j.jdermsci.2016.10.004","DOI":"10.1016\/j.jdermsci.2016.10.004"},{"key":"10.5826\/dpc.1603a6805_ref22","doi-asserted-by":"crossref","unstructured":"Shen S, O'Brien T, Yap LM, Prince HM, McCormack CJ. The use of methotrexate in dermatology: a review. Australas J Dermatol. 2012;53(1):1-18. DOI:10.1111\/j.1440-0960.2011.00839.x","DOI":"10.1111\/j.1440-0960.2011.00839.x"}],"container-title":["Dermatology Practical &amp; Conceptual"],"original-title":[],"link":[{"URL":"https:\/\/dpcj.org\/index.php\/dpc\/article\/download\/6805\/3932","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/dpcj.org\/index.php\/dpc\/article\/download\/6805\/3932","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T15:08:10Z","timestamp":1785510490000},"score":1,"resource":{"primary":{"URL":"https:\/\/dpcj.org\/index.php\/dpc\/article\/view\/6805"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":22,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.5826\/dpc.1603a6805","relation":{"has-manifestation":[{"id-type":"other","id":"1-84-6805-g3932","asserted-by":"subject"}],"is-part-of":[{"id-type":"doi","id":"10.5826\/dpc.1603a%a","asserted-by":"subject"}]},"ISSN":["2160-9381"],"issn-type":[{"value":"2160-9381","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]},"article-number":"4"}}