The spectrum of alopecia areata: Combination treatment with oral azathioprine and I/M injection triamcinolone acetonide as a bridging strategy

Abstract

Background  Alopecia areata (patchy alopecia) is an inflammatory disease which leads to hair loss over scalp and body. It is prevalent in 0.2% of the population without any racial or sexual predilection and may affect any age group and is prevalent in 25% of almost all alopecia cases.1 Azathioprine exerts its full effect after 4 to 6 weeks due to which most of our patients would leave treatment in initial phase of treatment. To cover up this issue of compliance and to increase its efficacy, we bridged this gap of 4 to 6 weeks with single shot of triamcinolone acetonide intramuscular injection. Although corticosteroids are effective in the treatment of alopecia areata whether administered intramuscularly, orally or intralesionally but since it is a chronic disorder and its long term use can lead to potential irreversible adverse effects, the need for steroid sparing immunosuppressive agents like azathioprine is recommended, which has favorable therapeutic action without many systemic side effects (success rate of 28.5 to 61%).   Objective To investigate the efficacy of azathioprine with triamcinolone acetonide as a bridging therapy for the management of alopecia areata and its spectrum.   Methods Two hundred patients with alopecia areata participated in an interventional single-arm pre and post-study at the Fauji Foundation Hospital in Rawalpindi from August 2018 to January 2021. After receiving consent, patients from dermatology OPD and inpatient settings were recruited. Patients were chosen using a non-probability consecutive sampling procedure.   Results Calculation of the SALT score was done using the given formula as pretreatment and 8 weeks post treatment score. There is a 40.3% decrease in SALT score 12 weeks after treatment; the mean pre-treatment score was 35.65±3.7SD. 8 weeks after treatment, SALT score was 20.65±3.7SD and the difference between mean SALT score before and after treatment is statistically significant (t=34.3, p=<0.05).