Intralesional Triamcinolone Acetonide in the Treatment of Traction Alopecia

density along the frontotemporal hairline. All patients had been instructed to avoid tension-related hair care practices.

Of the TA patients seen, 6 met the criteria for our observational study. All 6 were African American females presenting for evaluation of frontotemporal hair loss, with ages ranging from 32 to 61 years. All subjects reported a history of hairstyling that exerted tension to the frontotemporal hairline at some point in their lives, whether it was recent, during childhood, or both. The clinical diagnosis of TA was established through the presence of the fringe sign. Five subjects had 3 to 4 ILK injections done at 6 to 8-week intervals, performed at a concentration of 5 mg/mL, while one subject (Subject #2) received only one treatment with ILK (Table 1) also at a concentration of 5 mg/mL. Injections were done both at the border of the hair loss in the frontotemporal hairline and extending backwards to include the normal density hair. Subjects concurrently used topical minoxidil 5% daily, and one subject (Subject #2) also took oral doxycycline. All subjects reported the cessation of all hair care practices that exert tension to the frontotemporal hairline, including tight ponytails, tight hair braiding/weaving, twisting of locks, use of scarves to tie hair down, and the use of hair gel on the frontotemporal hairline. All subjects demonstrated a visible increase in hair density along the frontotemporal hairline following their third treatment (Figure 1). None of the subjects reported any serious adverse effects from the injections. The subject that received only one ILK treatment and continued dual therapy on minoxidil and doxycycline reported itch initially, which was improved with the use of a topical steroid.

This study shows that ILK, when used in conjunction with topical minoxidil, is effective in halting TA progression, and in improving frontotemporal hair density in patients with TA. Our patients reported no adverse systemic effects from the injections that are commonly associated with corticosteroids, and only one patient reported itch in the frontotemporal hairline, a symptom which is more likely a side effect of the topical minoxidil or a manifestation of the TA pathology itself.

Only one study describing the treatment of TA is available in the literature, and it only reports on outcomes with topical minoxidil use.⁹ Intralesional steroids have been used in the treatment of many dermatologic conditions, including scarring and nonscarring forms of alopecia. Its effectiveness is believed to be due its anti-inflammatory effects. Intralesional triamcinolone acetonide is particularly favored as the glucocorticoid agent of treatment in TA and several other dermatologic conditions because of its prolonged duration of action (which is longer than that of other triamcinolone salts).¹⁰ Furthermore, steroids administered intralesionally have the unique benefit of inserting a high concentration of medication to the affected area, more than would be possible from topical or oral steroids, while avoiding adverse systemic side effects. Side effects of intralesional corticosteroid injection include pain (due to the volume of fluid injected into the lesion, as well as the location of the injection—frontotemporal scalp tends to be the most sensitive area of the scalp), atrophy, and pigmentary changes at the site of injection.¹⁰

It is believed that subclinical inflammation may be a key component to the pathophysiology of the early stages of TA, which would explain the effectiveness of ILK in the treatment of TA. Some believe that the histological findings in cases of TA in the