Natalia Jennifer Handika, Ketut Kwartantaya Winaya, Kadek Devi Aninditha Intaran, Desak Putu Kunti Wedayanti, Ni Kadek Sri Rahayu Wijayanti

Severe recurrent alopecia areata treated with triamcinolone acetonide, minoxidil, clobetasol propionate, and vitamin D supplementation: a case report

Introduction

Severe recurrent alopecia areata treated with triamcinolone acetonide, minoxidil, clobetasol propionate, and vitamin d supplementation: a case report. Explore a case report on severe recurrent alopecia areata treated with triamcinolone acetonide, minoxidil, clobetasol propionate, and vitamin D supplementation, detailing significant hair regrowth.

Abstract

Introduction: Alopecia areata (AA) is a chronic inflammatory disease mediated by the immune system that affects hair follicles and nails. This condition targets anagen-phase hair follicles and causes hair loss without permanent follicular damage. In this study, we report a case of severe alopecia areata in a female patient treated with corticosteroid injections, minoxidil, topical corticosteroids, and vitamin D supplementation. Case description: A 21-year-old female presented with patches of hair loss on her scalp for the past year, progressively worsening. Initially, she experienced scalp itching, followed by gradual hair shedding. Dermatological examination revealed multiple alopecia patches on the scalp. The hair pull test was positive at the lesion's edges. Hair pluck test showed a higher ratio of telogen-phase hairs compared to anagen-phase hairs. Trichoscopic findings included yellow dots, short vellus hairs, black dots, broken hairs, and exclamation mark hairs. The patient was treated with triamcinolone injections, minoxidil, clobetasol propionate, and vitamin D supplementation, resulting in clinical improvement. Conclusions: Severe, recurrent AA treated with intramuscular triamcinolone acetonide, topical minoxidil, clobetasol propionate, and oral vitamin D supplementation showed significant improvement, particularly in hair regrowth.

Review

This case report presents an interesting account of a young female patient suffering from severe recurrent alopecia areata (AA) successfully managed with a multimodal treatment approach. Given the often challenging and recalcitrant nature of severe AA, the described therapeutic strategy, combining systemic and topical corticosteroids, a topical growth stimulant (minoxidil), and vitamin D supplementation, offers a valuable contribution to the clinical literature. The initial diagnostic findings, including trichoscopic features and hair pull/pluck tests, are well-documented and consistent with the diagnosis of active AA, establishing a solid foundation for the subsequent treatment narrative. While the abstract highlights clinical improvement, a more detailed presentation of the treatment regimen would significantly enhance the report's utility. Specifics regarding the dosage, frequency, and duration of intramuscular triamcinolone acetonide injections, topical minoxidil, and clobetasol propionate, as well as the dosage of oral vitamin D supplementation, are crucial for readers to understand and potentially replicate the intervention. Furthermore, the abstract mentions "recurrent" AA, yet does not elaborate on previous episodes, treatments, or their outcomes, which would provide critical context for classifying the current case as recurrent and evaluating the efficacy of the present regimen against past failures or remissions. A timeline correlating the initiation of each treatment component with the observed improvement would also be beneficial. Overall, this case report provides compelling evidence for the potential efficacy of a combined therapeutic approach in managing severe, recurrent AA. To maximize its impact and inform clinical practice, the full manuscript should elaborate on the details of the treatment protocol, the precise timeline of clinical response, and include objective measures of improvement, such as photographic documentation and quantifiable hair regrowth assessment (e.g., SALT scores). Addressing these points will undoubtedly strengthen the report, offering a more comprehensive and actionable insight into the successful management of this challenging dermatological condition.

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