A Fundamental Solution for Alopecia Areata with Local Steroid Injections

Hello.

This is Mutel Plastic Surgery.

When people who suddenly notice a round patch of hair loss somewhere on the scalp come in for a consultation and ask, “Is it because of stress?”, we usually answer, “It is likely alopecia areata, and it may be stress-related.”

Alopecia areata is an autoimmune disease in which one’s own immune cells attack the hair follicles, causing hair loss symptoms.

After severe stress, immunity can drop sharply, and the symptoms of alopecia areata may appear suddenly or hair loss may worsen.

So, what treatment should be done to calm this “attack” by immune cells?

One way to fundamentally address the cause of the condition is a “steroid injection.” Using medications such as triamcinolone, local injection treatment is performed directly into the lesion.

Today, I will explain in detail the principles, method, effectiveness, and expected outcomes of this treatment.

Why are steroid injections helpful?

The mechanism of alopecia areata is that inflammatory cells such as T lymphocytes gather around the hair follicles and stop hair growth.

Because steroids have strong anti-inflammatory and immunosuppressive effects, they can quickly respond to local inflammation and reduce it.

If steroids are used systemically, their effect may be greater, but side effects can also occur more often. Therefore, in the early stages, we choose to suppress inflammation and induce the hair follicles to re-enter the growth cycle by injecting steroids locally and directly into the lesion.

In other words, this is a treatment that “injects medication into the site of the problem to calm the inflammation.”

In what situations is it recommended?

When the lesion is small and in an early, localized stage, injection treatment can be considered most appropriate.

If the hair loss patch becomes larger or spreads to multiple areas, or if extensive hair loss occurs in sensitive areas such as the eyebrows or beard, then after evaluation by a dermatologist, higher-level treatments such as systemic steroids or immunotherapy may also need to be considered.

Therefore, during a consultation for alopecia areata, we carefully check when the hair loss symptoms first appeared, whether there has been recent stress or infection, and any history of medication use. We also look in detail at whether there is a personal autoimmune disease history or a family history.

For the scalp affected by alopecia areata, we check the size of the lesion, the degree of hair loss, and the condition of the surrounding skin. If necessary, we use magnification to assess the lesion’s “activity.”

If atypical findings or changes in pigmentation are present, a biopsy may be needed.

How is the procedure performed?

The medication most commonly used to treat alopecia areata is triamcinolone.

Usually, a diluted medication is used, and for the adult scalp, a concentration of 2–5 mg/mL is most commonly recommended.

The higher the concentration, the greater the effect of the drug, but the risk of side effects such as skin atrophy or pigmentation problems also increases. Therefore, setting an appropriate initial dose for each individual and gradually increasing it step by step is important.

Before the injection procedure, sterilization and disinfection are performed. Then, after choosing a thin 27G or 30G needle, a small amount of medication is injected between the epidermis and dermis so that tiny raised bumps appear. The procedure takes about 10 minutes.

Because the proper technique also requires injecting small amounts of medication in a distributed manner, reducing side effects and allowing safe treatment, it is most important to choose a medical team that can set an individualized dose and also has strong technical skill.

What side effects can occur?

Local side effects of the medication include skin atrophy, changes in pigmentation, and telangiectasia.

Choosing an excessive dose or performing injections too frequently can make these side effects more likely, so precise control of the concentration, number of treatments, and intervals is especially important.

Also, even if the injection is local, repeated administration of large amounts of steroid can lead to systemic absorption through the bloodstream, and it may even cause the representative systemic side effect of steroids, “Cushing syndrome.” Therefore, when treating multiple areas, using high concentrations, or performing procedures frequently, closer observation is needed.

Local steroid injection treatment tends to work better in early lesions that are active and where hair follicle damage is not severe.

On the other hand, for extensive diffuse or universal alopecia areata, or for long-standing scarred areas, local injections alone are often insufficient and additional treatment is frequently needed. Please find the optimal treatment under the diagnosis of a specialist.

Are there any procedures that can be done together?

While inflammation is suppressed with local steroid injections to address the cause of the disease and hair regeneration takes place, scalp SMP can be performed together to cover sparse areas.

SMP improves the appearance immediately after treatment and helps boost confidence. Therefore, both in alopecia areata and male pattern hair loss, it is an option that can be useful for covering areas where hair regrowth is slow during treatment.

However, pigment scalp implantation should be performed in the “stable phase” after the inflammatory response has subsided, and the tone and density should be carefully decided together with a specialist, taking future regrowth into account.

To conclude...

Local steroid injections are used as a useful tool to suppress inflammatory reactions in the early stages of stress-related alopecia areata and to promote hair recovery.

However, because of the nature of medication injected into the scalp, incorrect choices in concentration, dose, or treatment interval can lead to various side effects, so consultation and planning with a specialist are very important.

Also, not only for the initial treatment of hair loss but also for long-term maintenance and prevention of recurrence, lifestyle improvements, stress management, and, if necessary, combination with other medical treatments must be properly carried out in order to protect your precious hair for a long time.

That is all for today’s post from the Yongsan dermatology clinic, and if you have any other questions, please visit Mutel for a consultation.

We will always do our best to provide the best treatment tailored to each individual’s characteristics and condition.

This was Mutel Plastic Surgery.

Thank you.