Comparative study between topical methotrexate 1% gel and minoxidil 5% gel in the treatment of localized alopecia areata

Alopecia areata (AA) is an autoimmune disease that results in non-scarring hair loss. Topical minoxidil 5% gel and methotrexate (MTX) 1% gel are important modalities used in the treatment of many dermatological diseases. We aimed to evaluate the efficacy of MTX 1% gel versus topical minoxidil 5% gel in the treatment of localized AA both clinically and dermoscopically. A total of 50 patients were randomly divided into two groups of 25 each; the first was treated with topical minoxidil 5% gel and the second was with MTX 1% gel. Dermoscopic and photographic pictures were used to follow up at baseline, 3, 6, and 12 weeks. By comparing the two therapies, we noticed that minoxidil has a statistically significant higher frequency of broken hair and black dots after 6 weeks than MTX. After 12 weeks, dermoscopic revealed that the minoxidil group had a lower frequency of vellus hair than the MTX group. Clinically after 6 weeks, minoxidil showed significantly more excellent improvement than MTX (16% vs. 0%), after 12 weeks, minoxidil and MTX showed excellent improvement (52% and 36%), respectively. There was no significant difference in side effects (erythema and itching) between the MTX and minoxidil groups. Both topical MTX 1% gel and topical minoxidil 5% gel had high efficacy in treating localized AA, with no significant differences between them as evaluated by clinical and dermoscopic examination.

Automated summary

This study evaluated the efficacy of 1% methotrexate gel and 5% minoxidil gel in treating localized alopecia areata (AA). The results showed no significant difference between the two treatments based on clinical and dermoscopic examination, indicating that both topical methotrexate gel and topical minoxidil gel are effective in treating localized AA.