Abstract

Alopecia areata (AA) is a common inflammatory disease causing unpredictable nonscarring form of hair loss. It may affect some or all areas of body especially the scalp and is usually reversible. It was first described about 2000 years ago by Celsus [AD 1437]. Its frequency ranges from 0.7% to 3.8% of patients attending dermatology clinics. The characteristic lesion of AA is circumscribed, hairless, smooth patch. Short, easily extractable broken hairs known as exclamation mark hairs are often seen at margins of bald patches during active phase of disease. Sparing of grey hair is a relative phenomenon. Severe and recurrent cases of AA can disturb quality of life of patients and may also lead to depression, changed self-image and interferes with social activities (Masmoudi J et al., 2013) 1 . Multiple therapeutic modalities for AA have been reported including immunosuppressive treatments as corticosteroids (topical, intralesional, systemic), photochemotherapy, immunomodulatory treatments as diphenylcyclopropenone and other treatment options as Anthralin or Minoxidil (Hertl M et al., 2005) 2 . AA continues to be a challenging disease with less than 20% of patients obtaining complete long-term hair regrowth (Phan K et al., 2019) 3 . Intralesional corticosteroid is considered drug of choice for localized AA with less than 50% of scalp involvement in adults followed by topical corticosteroids, topical minoxidil, and anthralin (Ustuner P et al., 2017) 4 . Methotrexate is folic acid antagonist that acts as immunosuppressant used in treatment of several skin diseases. (Bressan AL et al., 2010) 5 . Systemic methotrexate has been used in treatment of AA with satisfactory results (Droitcourt C et al., 2012) 6 . So intralesional methotrexate can be compared to triamcinolone as therapeutic option for localized AA in adults

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