Comparative Evaluation of Superficial Cryotherapy vs Intralesional Triamcinolone in Alopecia Areata at a Tertiary Care Center: A Dermoscopic and Clinical Study in Middle-aged Adults

ReseaRch aRticleoutpatient-friendly approach, its efficacy is generally considered lower than ILT, particularly in rapidly progressive or longstanding patches. 6espite promising preliminary results, the role of cryotherapy in AA-especially in middle-aged patients-remains underinvestigated.This age group often experiences more stable immune profiles, potentially responding differently to local IntroductIonAlopecia areata (AA) is a chronic, immune-mediated disorder marked by nonscarring hair loss, often manifesting as discrete patches on the scalp and other hair-bearing areas.It affects approximately 1-2% of the population, with no significant gender predisposition. 1 Although commonly studied in children and young adults, AA in middle-aged adults presents unique clinical and psychosocial challenges due to their active occupational lives and heightened cosmetic expectations.The pathogenesis of AA involves T-cell-mediated autoimmune targeting of hair follicles, particularly those in the anagen phase, leading to their premature transition and arrest in growth. 2 Multiple therapeutic strategies exist, ranging from topical agents to systemic immunosuppressants. 3Among the localized options, intralesional corticosteroids, especially triamcinolone acetonide, are widely used due to their direct anti-inflammatory effects on perifollicular T-cell infiltration. 4nother modality, i.e., superficial cryotherapy, has gained attention for its nonpharmacological immunomodulatory mechanism, which may stimulate local blood flow and provoke perilesional immune resetting. 5While it offers a low-cost and 1-