Intralesional Steroid Treatment

Clinician-Led Treatment for Localised Alopecia Areata

Some patients with limited alopecia areata may be suitable for medication delivered directly into affected patches of skin.

This approach is used to reduce the local immune and inflammatory activity affecting the hair follicle, with the aim of allowing regrowth to occur where follicles remain viable.

Because this involves prescription medication, treatment is provided only following appropriate assessment and where clinically suitable.

Who May Be Suitable?

Intralesional corticosteroid treatment is most commonly considered for adults with limited mild-to-moderate alopecia areata.

The 2024 British Association of Dermatologists guideline recommends intralesional triamcinolone acetonide as a first-line option for adults with limited mild-to-moderate alopecia areata.

Suitability depends on factors including:

• Confirmation of the diagnosis
• Extent of hair loss
• Location of affected areas
• Duration and progression
• Previous treatment
• Medical history
• Individual risks and preferences

It is not a general treatment for male or female pattern hair loss.

What Does Treatment Involve?

Small amounts of medication are injected directly into or immediately beneath the affected skin.

Depending on the size and number of patches, several small injections may be required during a session.

Further sessions may be considered several weeks apart depending on response and clinical assessment. BAD patient guidance describes this as an established use of intralesional steroid therapy for alopecia areata.

What Are the Potential Side Effects?

Possible effects around the injection area include:

• Temporary pain or tenderness
• Small areas of bleeding
• Local infection
• Thinning or indentation of the skin
• Visible small blood vessels
• Changes in skin pigmentation

Local skin thinning is one of the more recognised risks and is one reason careful dosing and injection technique are important.

These risks will be discussed as part of the clinical consultation.

What Results Can I Expect?

Alopecia areata is unpredictable.

Hair may regrow spontaneously in some patients, while other patients experience persistent or recurrent disease.

Treatment may help encourage regrowth in suitable localised cases, but it cannot guarantee that hair loss will not recur elsewhere or at a later date.

More extensive or rapidly progressive alopecia areata may require a different treatment pathway.

A Wider Alopecia Care Plan

Depending on the severity of the condition, other options may include topical treatment, contact immunotherapy, specialist dermatology care or hair replacement.

Current BAD guidance recommends different treatment pathways according to severity rather than one treatment for every patient.