Treatment Outcomes of Triamcinolone Acetonide Compared with Cryotherapy in Alopecia Areata: Evidence from a Systematic Review and Meta-Analysis
Keywords:
Alopecia areata, Cryotherapy, Triamcinolone acetonideAbstract
Introduction: Alopecia areata (AA) is a common autoimmune hair loss disorder. Intralesional triamcinolone acetonide (IL-TAC) and cryotherapy are both used for patchy AA, but their comparative efficacy and safety have not been systematically evaluated.
Objectives: The primary objective was to compare the efficacy of IL-TAC versus cryotherapy in achieving ≥50% hair regrowth in patchy AA. Secondary objectives included comparing safety profiles and conducting subgroup analyses.
Methods: We conducted a systematic review and meta-analysis per PRISMA 2020 guidelines (PROSPERO: CRD420251036356). Databases (PubMed, Scopus, CENTRAL, Google Scholar) were searched up to April 2025. Comparative studies of patients with patchy AA receiving IL-TAC or cryotherapy were included. Risk of bias was assessed using ROB2 and ROBINS-I tools. A random-effects meta-analysis was performed for the primary outcome.
Results: 640 patients across five trials were included. Sensitivity analysis of four studies demonstrated IL-TAC significantly increased the likelihood of ≥50% hair regrowth compared to cryotherapy (RR: 1.57; 95% CI: 1.36–1.81, *p*<0.001), with low heterogeneity (I²=21%). Subgroup analyses by study design and randomization status found no significant differences. Adverse event profiles differed: IL-TAC was associated with injection-site pain and skin atrophy, while cryotherapy caused transient pain, swelling, and bullae.
Conclusions: Current evidence suggests IL-TAC is more effective than cryotherapy for significant hair regrowth in patchy AA, though both have distinct tolerability profiles. These findings support IL-TAC as a first-line procedural option, with cryotherapy remaining a viable alternative. Higher-quality comparative trials with standardized protocols and long-term follow-up are needed to confirm these findings.
References
Pratt CH, King LE, Messenger AG, Christiano AM, Sundberg JP. Alopecia areata. Nat. Rev. Dis. Primers. 2017;3(1). DOI:10.1038/nrdp.2017.11 PMID: 28300084
Mirzoyev SA, Schrum AG, Davis MDP, Torgerson RR. Lifetime incidence risk of alopecia areata estimated at 2.1% by Rochester Epidemiology Project, 1990–2009. J Invest Dermatol. 2013;134(4):1141-1142. DOI:10.1038/jid.2013.464 PMID: 24202232
Strazzulla LC, Wang EHC, Avila L, et al. Alopecia areata. J Am Acad Dermatol. 2017;78(1):1-12. DOI:10.1016/j.jaad.2017.04.1141 PMID: 29241771
Lee S, Lee H, Lee CH, Lee WS. Comorbidities in alopecia areata: A systematic review and meta-analysis. J Am Acad Dermatol. 2018;80(2):466-477.e16. DOI:10.1016/j.jaad.2018.07.013 PMID: 30031145
Bertolini M, McElwee K, Gilhar A, Bulfone‐Paus S, Paus R. Hair follicle immune privilege and its collapse in alopecia areata. Exp. Dermatol. 2020;29(8):703-725. DOI:10.1111/exd.14155 PMID: 32682334
Żeberkiewicz M, Rudnicka L, Malejczyk J. Immunology of alopecia areata. Cent. Eur. J. Immunol. 2020;45(3):325-333. DOI:10.5114/ceji.2020.101264 PMID: 33437185
Cranwell WC, Lai VW, Photiou L, et al. Treatment of alopecia areata: An Australian expert consensus statement. Australas J Dermatol. 2018;60(2):163-170. DOI:10.1111/ajd.12941 PMID: 30411329
Sterkens A, Lambert J, Bervoets A. Alopecia areata: a review on diagnosis, immunological etiopathogenesis and treatment options. Clin. Exp. Med. 2021;21(2):215-230. DOI:10.1007/s10238-020-00673-w PMID: 33386567
Kumaresan M. Intralesional steroids for alopecia areata. Int. J. Trichology. 2010;2(1):63. DOI:10.4103/0974-7753.66920 PMID: 21188031
Clebak KT, Mendez-Miller M, Croad J. Cutaneous Cryosurgery for Common Skin Conditions. Am Fam Physician. 2020;101(7):399-406. PMID: 32227823
Kwack MH, Lee S, Lee EH, Ha GU, Kim GH, Lee WJ. Effect of a Precision Cryotherapy Device with Temperature Adjustability on Pigmentation. Indian J. Dermatol. 2022;67(2):204. DOI:10.4103/ijd.ijd_755_21 PMID: 36092232
Bangaru H, Mishra S, Sachan SS, Ramrakhiani S. Observational Study with a New Portable Cryosurgery Device, HYDROZID®, in Superficial Epidermal Lesions: An Indian Experience. Indian J. Dermatol. 2024;69(6):425–431. DOI:10.4103/ijd.ijd_636_23 PMID: 39678739
Gupta AK, Carviel JL, Foley KA, et al. Monotherapy for Alopecia areata: A Systematic Review and Network Meta-Analysis. Skin Appendage Disorders. 2019;5(6):331-337. DOI:10.1159/000501940 PMID: 31799258
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. Published online March 29, 2021:n71. DOI:10.1136/bmj.n71 PMID: 33782057
Sterne J a C, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. Published online August 28, 2019:l4898. DOI:10.1136/bmj.l4898 PMID: 31462531
Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. Published online October 12, 2016:i4919. DOI:10.1136/bmj.i4919 PMID: 27733354
Mohammed AIA, Farag AS, Hafiz HSA. Superficial cryotherapy versus intralesional corticosteroid injection in alopecia areata: A comparative Clinical and dermoscopic study. Egypt. J. Hosp. Med. 2022;86(1):211-217. DOI:10.21608/ejhm.2022.211050
Sayed MHE, Ibrahim NED, Afify AA. Superficial cryotherapy versus intralesional corticosteroids injection in alopecia areata: A trichoscopic comparative study. Int. J. Trichology. 2022;14(1):8-13. DOI:10.4103/ijt.ijt_130_20 PMID: 35300102
Sardana S, Goyal T, Kushwaha P, Jha P. A prospective study to compare the efficacy of cryotherapy versus intralesional steroid in alopecia areata. J. Cutan. Aesthet. Surg. 2022;15(2):175. DOI:10.4103/jcas.jcas_166_20 PMID: 35965906
Ranjkesh MR, Amirnia M, Mahmoudi SS, et al. Comparative study of intralesional steroid injection and cryotherapy in alopecia areata. Niger Med J. 2015;56(4):249. DOI:10.4103/0300-1652.165034
Akram S, J Tan I, R Shah R, Tariq Z, Javaid H, Rao B. Comparative Efficacy of Intralesional Steroid Injections vs Cryotherapy for the Treatment of Alopecia Areata. J Drugs Dermatol. 2025;24(3):294-297. DOI:10.36849/JDD.8499
Kaiser M, Issa N, Yaghi M, Jimenez JJ, Issa NT. Review of superficial cryotherapy for the treatment of alopecia areata. J. Drugs Dermatol. 2023;22(8):802-809. DOI:10.36849/jdd.7431PMID: 37556514
Mendoza TR, Osei J, Duvic M. The Utility and Validity of the Alopecia Areata Symptom Impact Scale in Measuring Disease-Related Symptoms and their Effect on Functioning. J. Investig. Dermatol. Symp. Proc. 2017;19(1):S41-S46. DOI:10.1016/j.jisp.2017.10.009 PMID: 29273105
Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)-a simple practical measure for routine clinical use. Clinical and Exp. Dermatol. 1994;19(3):210-216. DOI:10.1111/j.1365-2230.1994.tb01167.x PMID: 8033378
Kumaresan M. Intralesional steroids for alopecia areata. Int. J. Trichology. 2010;2(1):63. DOI:10.4103/0974-7753.66920 PMID: 21188031
Chu TW, AlJasser M, Alharbi A, Abahussein O, McElwee K, Shapiro J. Benefit of different concentrations of intralesional triamcinolone acetonide in alopecia areata: An intrasubject pilot study. J Am Acad Dermatol. 2015;73(2):338-340. DOI:10.1016/j.jaad.2015.04.049 PMID: 26183987
Rho NK. Revisiting the role of local cryotherapy for acne treatment: A review and update. J. Clin. Med. 2022;12(1):26. DOI:10.3390/jcm12010026 PMID: 36614827
King BA, Craiglow BG. Janus kinase inhibitors for alopecia areata. J Am Acad Dermatol. 2023;89(2):S29-S32. DOI:10.1016/j.jaad.2023.05.049 PMID: 37591562
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