Steroid injections are employed as a treatment to address specific types of hair loss. They prove effective in cases of hair loss where the body’s immune system mistakenly targets hair follicles. Ideally, the immune system defends against infections, but in certain hair loss conditions, it wrongly attacks hair follicles, resulting in hair loss. Steroids can intervene to prevent the immune system from causing damage to the hair follicles.

Intralesional steroid injections refer to a treatment method for specific hair loss conditions. This technique involves the direct injection of steroid medication into the affected skin area where hair loss is present. The purpose of this localized approach is to concentrate the effects of steroids precisely where needed, minimizing the potential for side effects resulting from the systemic absorption of steroids throughout the body.

Steroid injections can also be administered in larger doses through muscle injection or intravenously, allowing the medication to circulate throughout the entire body. However, this article focuses on intralesional steroid injections and does not cover the use of high-dose steroid injections into muscles or veins.

Steroid injections are utilized to address the following hair loss conditions:

1. Alopecia areata of the scalp when affecting less than 50% of the scalp area.
2. Alopecia areata of the eyebrows.
3. Alopecia areata of the beard.
4. Lichen plano pilaris.
5. Frontal fibrosis alopecia.
6. Discoid lupus.
7. Folliculitis decalvans.

Steroid injections are not effective for male or female pattern hair loss, telogen effluvium, advanced traction alopecia, and other hair loss conditions not listed above.

Which steroid injection is used?

The standard steroid employed for hair loss injections is Triamcinolone acetonide, available under brand names like Adcortyl and Kenalog-10.

In cases of alopecia areata, steroid injections can stimulate hair regrowth. Steroid injections have been used for alopecia areata since 1958. Studies from the 1970s demonstrated that 71% of individuals with Alopecia Areata experienced hair regrowth when treated every 2 weeks for three sessions. Another study reported that 63% of those receiving monthly steroid injections witnessed regrowth after 4 months. The success of regrowth is influenced by factors like the number of patches (fewer than 5), patch size (less than 3cm in diameter), and lesion duration (less than 1 month).

It’s important to note that steroid injections do not provide a cure for alopecia areata, and regrown hair can be lost, with the condition recurring in the same or different areas later. While steroid injections are beneficial for a significant number of patients, they are not effective for everyone, and results are not guaranteed

Steroid injections are employed to manage inflammation in conditions like Lichen planopilaris, Frontal fibrosis alopecia, and Discoid lupus. These injections work in tandem with other treatments, such as creams or tablets, to slow down the progression of these conditions.

Steroid injections may lead to minor pinpoint bleeding at the injection sites. It’s advisable to avoid disturbing the area until the next day when activities like shampooing and shaving are permitted.

Possible mild side effects can include headaches and soreness, typically resolving within an hour or two, with the option to take Paracetamol if necessary.

One significant concern is skin thinning, as steroid injections can thin the skin and the underlying fat. This can result in paler and more wrinkled skin, sometimes displaying thread veins or dimples. Skin indentations are often temporary and will recover with time.

Pigmentation disturbances may occur very rarely, manifesting as either loss of pigmentation or hyperpigmentation at the injection site.

Steroid injections could lead to acne or folliculitis-type spots (pustules) in the treated area.

Absorption into the rest of the body may occur to some extent, especially when treating large areas. In these cases, side effects such as diabetes, high blood pressure, bone thinning, menstrual cycle irregularities, and a temporary reduction in the immune system might be possible. However, these risks are minimal when using the typical steroid doses for hair loss. Using a lower concentration of the steroid solution and spreading it evenly across the area with multiple small-volume injections via a fine syringe can further reduce the risk of these side effects to less than 5%.

Treatment is typically administered every 4 weeks for up to 6 months. The number of treatments needed varies from person to person. Some individuals may require only one or two treatments, while others may need the full 6-treatment course. On average, most individuals benefit from 3 to 4 treatments, and treatment is not extended beyond 6 sessions if no results are observed.

It is believed that steroid injections are most effective within the first month of developing an alopecia areata patch. Controlling inflammation early may also quiet down the immune system, potentially preventing the emergence of hair loss patches elsewhere on the scalp, although this has not been conclusively proven. Nevertheless, steroid injections can be administered at any stage, as advised by your healthcare provider, even one or two years after the patch’s appearance.

The procedure commences with cleansing the skin using an antiseptic cleanser. Intralesional steroid injections are performed using a micro-droplet technique. A fine needle is used to deliver small droplets at multiple sites within the affected area. This approach ensures an even distribution of the medication and reduces the risk of side effects. The treatment is brief, lasting between 5 to 10 minutes, and anesthesia is typically not required.