Intralesional Triamcinolone Acetonide in the Treatment of Traction Alopecia

literature may be skewed towards late stage disease, a stage where signs of inflammation are not usually histologically apparent. ¹¹ However, in a study by Whiting, 24 patients with TA were identified, and histological findings included significant lympho-histiocytic inflammation around 14% of the lower and 38% of the mid and upper hair follicles in this cohort.¹² Significant scarring was also present around 50% of the lower and around 86% of the mid and upper follicles in this group.¹² In our study, clinical signs of inflammation, such as pustules, erythema, and flaking were not appreciated, however treatment with anti-inflammatory agents proved to be quite effective. Despite the scarring that can be seen, this study suggests that existing hair follicles can be recruited to grow terminal hairs with treatment, at least in the early to mid-stage cases.

We recommend treatment with ILK at a concentration of 5mg/ mL, to minimize risk of atrophy. Injections can be performed at intervals of 6 to 8 weeks, and a total of 3 treatments should be sufficient to determine if response will occur. Additionally, daily use of topical minoxidil 5%, and avoidance of traction at the hairline will likely maximize positive outcomes, as the minoxidil presumably prolongs the anagen phase of the growing hairs. As minoxidil can cause mild hypertrichosis, scalp irritation, or mild shedding early in treatment, these possible side effects should be discussed with patients before prescribing this medication. Finally, we recommend that all patients with TA for whom treatment is started have baseline and follow-up photographs taken. Photographic record of progress can be helpful to both clinicians and patients to fully appreciate the effectiveness of treatment.

The author, Amy J. McMichael, is a consultant for the following companies: Allergan, eResearch Technology, Inc., Galderma, Guthey Renker, Johnson & Johnson, Keranetics, Merck & Co., Inc., Merz Pharmaceuticals, Proctor & Gamble, Samumed, and Incyte. Amy J. McMichael receives grants from Allergan and Proctor & Gamble and has conducted research for Samumed. Amy J. McMichael receives royalties from UpToDate. The authors Laura Uwakwe, Andrea Tovar-Garza, and Brianna De Souza have no conflicts to disclose.

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