PATCH-TYPE ALOPECIA AREATA TREATED WITH COMBINATION THERAPY OF INTRALESIONAL CORTICOSTEROID, MINOXIDIL, AND VITAMIN D

Abstract

ABSTRACT

Patch-type alopecia areata is a nonscarring hair loss disorder that may clinically resemble tinea capitis, making accurate diagnosis essential for appropriate management. This case report aimed to describe the diagnostic process, treatment, and short-term clinical response in an 18-year-old male with patch-type alopecia areata of the occipital region. A descriptive case report was conducted through dermatological examination, hair pull test, trichoscopy, potassium hydroxide (KOH) examination of hair roots, thyroid-stimulating hormone (TSH), free thyroxine (FT4), indirect immunofluorescence antinuclear antibody (ANA-IF), serum 25-hydroxyvitamin D [25(OH)D], and severity assessment using the Severity of Alopecia Tool (SALT) and Alopecia Areata Investigator Global Assessment (AA-IGA). Examination revealed several well-demarcated, skin-colored alopecic patches without scaling or scarring. The hair pull test was negative, trichoscopy showed exclamation mark hairs, and KOH examination was negative for fungal elements, supporting the diagnosis of patch-type alopecia areata. The patient received intralesional triamcinolone acetonide 10 mg/mL, topical minoxidil 5% spray, clobetasol propionate 0.05% cream, and oral vitamin D 2,000 IU. On day 18, no new patches were observed, with vellus and short terminal hair regrowth. The SALT score decreased from 20% to 10%, while AA-IGA remained at stage 1. The findings indicate short-term clinical improvement during multimodal therapy, although the response cannot be attributed to any single treatment component.

ABSTRAK

Alopesia areata tipe patch merupakan alopesia non-sikatrik yang dapat menyerupai tinea capitis, sehingga pemeriksaan klinis dan penunjang diperlukan untuk memastikan diagnosis pada kerontokan rambut terlokalisasi. Laporan kasus ini bertujuan menggambarkan proses diagnosis, tatalaksana, dan respons klinis jangka pendek pada pasien dengan alopesia areata tipe patch regio oksipital. Laporan kasus deskriptif dilakukan pada laki-laki berusia 18 tahun dengan keluhan kebotakan pada kulit kepala. Evaluasi meliputi pemeriksaan dermatologis, hair pull test, trikoskopi, KOH akar rambut, TSH, FT4, ANA-IF, kadar serum 25(OH)D, serta penilaian keparahan menggunakan Severity of Alopecia Tool (SALT) dan Alopecia Areata Investigator Global Assessment (AA-IGA). Pemeriksaan menunjukkan beberapa patch alopesia sewarna kulit, berbatas tegas, tanpa skuama atau jaringan parut, hair pull test negatif, exclamation mark hairs pada trikoskopi, dan KOH negatif terhadap elemen jamur, yang mendukung diagnosis alopesia areata tipe patch. Pasien mendapat kombinasi triamsinolon asetonid intralesi 10 mg/mL, minoksidil 5% spray topikal, klobetasol propionat 0,05% krim, dan vitamin D 2.000 IU per oral. Pada hari ke-18, tidak ditemukan patch baru dan tampak pertumbuhan rambut vellus serta terminal pendek. Skor SALT menurun dari 20% menjadi 10%, sedangkan AA-IGA tetap stadium 1. Perbaikan klinis menunjukkan respons jangka pendek selama terapi multimodal dan tidak dapat diatribusikan pada satu komponen terapi.