Successful Treatment of Long Standing Alopecia Totalis with Intralesional Methotrexate.

Alopecia areata (AA) is an autoimmune disease that targets anagen follicles causing nonscarring hair loss through chronic follicular inflammation. Despite presenting mostly as areas of localized hair loss, it can progress into alopecia totalis (AT) with complete hair loss of the scalp, or into a more severe form of entire body hair loss known as alopecia universalis (AT).1 Methotrexate (MTX) is an immunosuppressant folic acid antagonist medication used in a multitude of skin conditions. Recent reports examined (MTX) as a monotherapy or as an adjunct treatment for cases of AA .2 We report intradermal MTX as an alternative treatment for a resistant case of alopecia totalis with a good outcome.