In clinics across the United States, dermatologists treating alopecia may be using a range of intralesional corticosteroid techniques that often vary depending on the type of hair loss their patients face.
A recent national survey has mapped these practice patterns, offering one of the most detailed snapshots to date of how dermatologists approach scarring, nonscarring, and facial alopecia.
In the absence of standardized guidelines, intralesional corticosteroids—primarily triamcinolone—remain common treatment options. To better understand current practices, researchers surveyed 28 academic dermatologists with hair expertise. Among them, 21 responded, yielding a 75% response rate. Respondents averaged 17.7 years of experience, with training completion ranging from 1985 to 2022.
For nonscarring alopecia, 85.7% of the dermatologists used a triamcinolone concentration of 5 mg/mL. Nearly all (95.2%) injected 1 to 1.5 mL per session, used a 30-gauge needle, and preferred a 0.5-in needle. Most (95.2%) applied a grid injection pattern, spacing sites 1 cm apart in 66.7% of cases. The majority injected to the dermis (90.5%) and typically performed six sessions, whereas 76.2% reported no maximum number of sessions. Treatment intervals were most commonly every 6 weeks (61.9%).
For scarring alopecia, 71.4% used the same technique as for nonscarring alopecia. Among those who adjusted, 60% used 5 mg/mL, while others used higher concentrations up to 10 mg/mL or more. Injection volumes ranged, with 40% administering 1 to 1.5 mL per session and 60% injecting 2 to 2.5 mL. All injected to the dermis.
Facial alopecia treatments showed greater variation. A concentration of 2.5 mg/mL was used by 80% of the dermatologists. Injection volumes of 1 to 1.5 mL per session were reported by 65%. Injections targeted the dermis in 90% of cases. Most performed three to four sessions, with 45% performing three or fewer, and 45% performing four sessions. Treatment intervals were generally every 6 weeks (55%).
The dermatologists provided additional procedural recommendations. For nonscarring alopecia, aligning the needle parallel to hair growth may reduce discomfort. In scarring alopecia, peripheral injections were often administered first, then moved toward the lesion’s center. For facial injections, the respondents advised reducing depth as a result of thinner dermis and avoiding visible vessels to minimize atrophy and bruising.
While some consistent patterns emerged, variation remained in triamcinolone concentration, injection volume, spacing, and session frequency. Prior clinical data cited by the researchers showed that concentrations of 2.5, 5, and 10 mg/mL may offer similar efficacy for localized patchy alopecia areata, suggesting that further investigation is needed to optimize dosing while limiting corticosteroid exposure.
Study limitations included the small sample size and selection of participants from the researchers’ professional networks. Nevertheless, the findings provided a rare glimpse into how U.S. dermatologists are currently tailoring intralesional corticosteroid treatments for diverse types of alopecia.
Full disclosures are available in the published study.
Source: JAAD International
