الفهرس 
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Abstract
A
lopecia areata is an acquired autoimmune disease, affecting approximately 2% of the world population. It is formed of non-cicatricial patches of hair loss. It is commonly associated with other autoimmune diseases, among which atopy and autoimmune thyroiditis are the most common. Alopecia areata can appear at any time, and it significantly impairs the patient’s quality of life.
The pathogenesis of AA is not completely clear, although it is well-established that genetic and environmental factors contribute to its development. Autoimmune attack of the hair follicles due to the collapse of the immune privilege (IP) of the anagen hair bulb is considered to play the main role in AA development.
Studies have shown increased TNF-α in patients by affected by alopecia areata patients’ serum and tissue. It has been found to induce formation of club-like hair follicle, similar to catagen stage.
Methotrexate was found to decrease TNF-α level by releasing adenosine in extracellular space and inhibiting immune cells.
This prospective cohort study was carried out on 15 patients diagnosed as having alopecia areata. All patients were selected from the dermatology outpatient clinic, Ain-Shams University Hospitals. An informed written consent was taken from each patient, after explanation of the technique, expectations, possible side effects and alternative treatments.
All patients were subjected to full history taking, general examination and dermatological examination. The disease characteristics were recorded as regards duration of current attack, past history of recurrences and history of associated autoimmune diseases. The disease severity was evaluated according to SALT score. Digital photographic documentation was done.
Evaluation of TNF-α tissue level was done at baseline (week 0) before starting the treatment via taking a biopsy for ELISA analysis and after treatment with intralesional methotrexate (one session every other week) for a maximum of 3 months or achievement of full remission whichever nearer.
A statistically significant improvement of SALT score and dermoscopic findings with statistically significant reduction of TNF-α tissue level after intralesional methotrexate treatment.
SALT score improvement was found to be significantly higher in female patients and patients without ophiasis. Moreover, severity of the disease represented by initial SALT score was found to be statistically higher with younger age of onset of the disease and age of patient. Statistically less improvement of SALT score after 3 months was found in patients with associated autoimmune diseases, atopy and in patients with history of previous recurrences. In addition to statistically less improvement of SALT score after 6 months was found in patients with ophiasis and history of atopy.
Moreover, TNF-α tissue level before treatment was found to be significantly lower in patients with longer disease duration and in with history of recurrence.
Relapse of disease activity was found to be statistically higher in male patients and younger age groups. No significant side effects for intralesional methotrexate was reported.
Finally, we concluded that intralesional methotrexate is an effective treatment for alopecia areata with reduction of TNFα tissue level while TNF-α tissue level was found to be related to disease activity but not severity.