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.