Treatment Outcomes of Triamcinolone Acetonide Compared with Cryotherapy in Alopecia Areata: Evidence from a Systematic Review and Meta-Analysis

Introduction: Alopecia areata (AA) is a common autoimmune hair loss disorder. Intralesional triamcinolone acetonide (IL-TAC) and cryotherapy are both used for patchy AA, but their comparative efficacy and safety have not been systematically evaluated. Objectives: The primary objective was to compare the efficacy of IL-TAC versus cryotherapy in achieving ≥50% hair regrowth in patchy AA. Secondary objectives included comparing safety profiles and conducting subgroup analyses. Methods: We conducted a systematic review and meta-analysis per PRISMA 2020 guidelines (PROSPERO: CRD420251036356). Databases (PubMed, Scopus, CENTRAL, Google Scholar) were searched up to April 2025. Comparative studies of patients with patchy AA receiving IL-TAC or cryotherapy were included. Risk of bias was assessed using ROB2 and ROBINS-I tools. A random-effects meta-analysis was performed for the primary outcome. Results: 640 patients across five trials were included. Sensitivity analysis of four studies demonstrated IL-TAC significantly increased the likelihood of ≥50% hair regrowth compared to cryotherapy (RR: 1.57; 95% CI: 1.36–1.81, *p*<0.001), with low heterogeneity (I²=21%). Subgroup analyses by study design and randomization status found no significant differences. Adverse event profiles differed: IL-TAC was associated with injection-site pain and skin atrophy, while cryotherapy caused transient pain, swelling, and bullae. Conclusions: Current evidence suggests IL-TAC is more effective than cryotherapy for significant hair regrowth in patchy AA, though both have distinct tolerability profiles. These findings support IL-TAC as a first-line procedural option, with cryotherapy remaining a viable alternative. Higher-quality comparative trials with standardized protocols and long-term follow-up are needed to confirm these findings.