Department of Dermatology and Sexually Transmitted Diseases, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Indian J Dermatol Venereol Leprol. 2013 May-Jun;79(3):408-17. doi: 10.4103/0378-6323.110767.
Intralesional corticosteroids are the treatment of choice for adults with less than 50% of scalp area involvement with alopecia areata. The sensitivity of picking up clinical response to treatment by clinical examination is very variable and has inter individual variation.
To evaluate the efficacy of intralesional triamcinolone acetonide in the treatment of alopecia areata and to use dermoscopy to identify signs of early clinical response and adverse effects.
Seventy patches in 60 patients were injected with steroid at 4 weeks interval and followed up for 24 weeks. Treatment response was evaluated using regrowth scale (RGS). Heine DELTA 20; dermatoscope was used to assess disease activity, response to treatment and side effects.
Twenty eight patients responded early and achieved RGS of 4 within 12 weeks and 29 patients responded late and achieved RGS of 4 within 24 weeks of initiating therapy. There were 3 patients who did not achieve RGS of 4 at 24 weeks. Late and incomplete responders showed statistically significant association with family history of alopecia areata (p < 0.0001), presence of recurrent disease (p = 0.0147) and presence of nail changes (p = 0.0007). Dermoscopically, 60 patches demonstrated regrowth of new vellus hair at 4 weeks. Tapering hair disappeared maximally at 4 weeks. At 12 weeks, complete disappearance was seen in tapering hairs, broken hairs and black dots whereas for yellow dots to disappear completely in all patches it took 16 weeks. The adverse effects were observed at an earlier stage using dermoscopy than clinically.
Intralesional triamcinolone acetonide is efficacious for treatment of localized patchy alopecia areata. Dermoscopy is very useful to identify signs of early clinical response, adverse effects and markers of disease activity.
对于头皮受累面积小于 50%的斑秃成人患者，皮损内注射皮质类固醇是首选治疗方法。通过临床检查来判断治疗的临床反应的敏感性差异很大，存在个体间的差异。
评估皮损内曲安奈德治疗斑秃的疗效，并使用共聚焦激光皮肤显微镜（dermoscopy）来识别早期临床反应和不良反应的迹象。
对 60 例 70 个斑秃患者，每 4 周进行一次皮质类固醇皮损内注射，并随访 24 周。使用再生量表（regrowth scale，RGS）评估治疗反应。使用 Heine DELTA 20 共聚焦激光皮肤显微镜评估疾病活动度、治疗反应和不良反应。
28 例患者在 12 周内早期达到 RGS4，29 例患者在 24 周内晚期达到 RGS4。有 3 例患者在 24 周时未达到 RGS4。晚期和不完全反应者与斑秃家族史（p < 0.0001）、疾病复发（p = 0.0147）和指甲改变（p = 0.0007）显著相关。皮损内注射后 4 周，60 个斑秃中共有 60 个显示出新的毳毛再生。在 4 周时，脱发的 Tapering 现象消失最多。在 12 周时，所有斑秃中的 Tapering 毛发、断发和黑点完全消失，而黄点则需要 16 周才能完全消失。使用共聚焦激光皮肤显微镜比临床更早地观察到不良反应。
皮损内注射曲安奈德治疗局限性斑秃有效。共聚焦激光皮肤显微镜非常有助于识别早期临床反应、不良反应和疾病活动的迹象。
