Hair Experts Report Varying Steroid Techniques for Alopecia

Medscape

17-06-2025

A national survey found broad consensus among hair experts on the use of intralesional corticosteroid (ILC) injections for alopecia but highlighted inconsistencies in dosing and injection parameters.
METHODOLOGY:
Researchers surveyed 28 dermatologists with hair expertise using a 77-question REDCap survey.
Participants averaged 17.7 years of experience, with completion of residency between 1985 and 2022.
The response rate was 75% (21 experts completed the survey).
The survey assessed ILC injection techniques across alopecia types, including facial alopecia.
TAKEAWAY:
For nonscarring alopecia, 5 mg/mL was the most common ILC dose (85.7%), followed by 2.5 mg/mL (38.1%); 95.2% of experts injected between 1 and 1.5 mL per session, 95.2% used a 30-gauge needle, and 95.2% injected in a grid pattern.
Most experts (71.4%) employed identical ILC techniques for both scarring and nonscarring alopecia, with 61.9% and 60%, respectively, preferring 6-week treatment intervals. The most common ILC dose for scarring alopecia was 5 mg/mL (60%), followed by 7.5 mg/mL (40%) and 10 mg/mL or more (40%).
For facial alopecia, 80% of experts used a lower concentration of 2.5 mg/mL, and 90% typically performed 3-4 sessions.
For nonscarring alopecia, experts suggested injecting parallel to the direction of hair growth to reduce pain and avoid follicle damage, and for scarring alopecia, they recommended starting with peripheral injections and moving toward the center of the lesion. For facial alopecia, experts recommended shallow injections and avoiding visible vessels to prevent atrophy and bruising.
IN PRACTICE:
'Our findings reveal general agreement amongst experts on the use of ILCs for alopecia; however, variation remains in concentration, injection spacing, and treatment duration, especially for facial and scarring alopecia,' the study authors wrote. Although a Delphi study 'could help standardize' ILC treatment approaches, they added, their results 'provide practical guidance for dermatologists on intralesional corticosteroid techniques for the treatment of various alopecia types.'
SOURCE:
This study was led by Noelle Desir, Department of Dermatology, University of Pennsylvania, Philadelphia, and was published online on June 3 in JAAD International .
LIMITATIONS:
Limitations included the hair expert identification process and potential response bias in the survey.
DISCLOSURES:
This study did not receive any funding. One study author reported serving as a consultant, advisory board member, speaker, and investigator for various pharmaceutical and cosmetic companies, including AbbVie, Arcutis Biotherapeutics, Pfizer, and L'Oréal, and also reported receiving royalties from McGraw Hill. Another author reported serving as an advisory board member for Beiersdorf. The remaining authors reported no conflicts of interest.