Mechanism of action- Immunosuppression is main mechanism of action.
Intralesional Corticosteriods
Intralesional corticosteriods injection is first line therapy for adult patient with less than 50 % scalp involvement.
For circumscribed lesion ,intralesional corticosteroids is first line treatment.
Triamicinolone acetonide is drug of choice. 5mg/mL with maximum of 3ml of triamicilone acetonide is injected intralesional with 30-gauge needle.
Initial growth is ofen seen in 4 to 8 weeks.
Trearment is repeated every 4 to 6 weeks.
Main side effect is atropy of scalp.
Children below 10 years are usually are not treated with intralesional corticosteroids.
If after 6 month there is no response ,discontinue the treatment.
The use of 0.05% Betamethasone dipropionate cream,0.05% clobestole propionate and 0.2% fluocinoloneacetonite crean has been advised for hair growth.
Primary complication from the use of steroid is skin atrophy, telangiectasia and folliculitis which are reversible on cessation of treatment. Little is known about adrenal suppression with use of topical steroids.
Oral steroids may be useful in active disease .Oral prednisone is most commonly used drug. Dose is usually 0.8 mg/kg with tapering dose regime over period of 6 weeks. Methylprednisolone inj. may used for extensive and recent disease