Combined Restylane and Triamcinolone Acetonide Injections for the Treatment of Alopecia Areata
Condition: Alopecia Areata
MeSH terms: Alopecia; Alopecia Areata
Intervention: Intralesional Triamcinolone Acetonide 10 mg/mL (Kenalog-10); Restylane
Intervention description: Intralesional injections of 4mLs Triamcinolone Acetonide 10 mg/mL (Kenalog-10) on the whole scalp; Intralesional injections of 2mLs of Restylane on one side of the scalp
Intervention MeSH terms: Triamcinolone; Triamcinolone Acetonide; Triamcinolone hexacetonide; Triamcinolone diacetate
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 14.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      The investigators hypothesize that Restylane® could serve as a repair matrix which also
      maintains IL triamcinolone acetonide concentrations at higher levels for a longer period of
      time in the skin, giving a more sustained local anti-inflammatory effect and thus, arresting
      the AA process and promoting hair regrowth. Furthermore, the combination of Restylane® with
      IL triamcinolone acetonide injections may prevent a common side effect, atrophy. With the
      prevention of scalp atrophy and the preservation of higher concentrations of triamcinolone
      acetonide for longer periods of time, patients may see a better clinical response for a
      longer period of time. Quality of life may improve as the number of clinic visits decreases
      as would the number of IL corticosteroid injections.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Men and women ages 18 and greater.

          2. Alopecia areata diagnosis in the last two years with extensive scalp involvement,
             between 74% and 99%, alopecia areata must involve the left and right hemispheres of
             the scalp.

          3. Willing to abstain from use of over the counter products and prescription products,
             other than study medications, which may promote hair growth.

          4. Willing to abstain from the use of non-steroidal anti-inflammatory medications,
             aspirin, St. Johns Wart, and high doses of Vitamin E supplementation.

          5. Subjects are capable of giving informed consent.

          6. Willing to adhere to protocol, including scalp examinations and photography.

        Exclusion Criteria:

          1. Allergy or intolerance to Restylane® or hyaluronate preparations

          2. Allergy or intolerance to triamcinolone acetonide, 10 mg/cc.

          3. Underlying disease that might be adversely affected by Restylane® or triamcinolone
             (ex. patients with bleeding disorders).

          4. Immunosuppressed patients (history of transplantation, cancer, chemotherapy,
             splenectomy, HIV).

          5. Pregnant or lactating female.

          6. Application of topical immunomodulatory or immunosuppressive agent in the preceding 6
             weeks.

          7. Systemic administration of corticosteroid or other systemic treatment (i.e.
             prednisone) that has immunomodulatory or other immunosuppressive mechanism of action,
             in the preceding 8 weeks.

          8. Clinical evidence of secondary skin infection (i.e., folliculitis).

          9. Other inflammatory or infectious skin disease that might interfere with evaluations
             during the study.

         10. Investigational medications within the past 30 days.

         11. Patients with susceptibility to keloid formation.

         12. Severe allergies manifested by a history of anaphylaxis, or history or presence of
             multiple severe allergies

         13. Patients with allergies to gram positive bacterial proteins

         14. Unable to give consent.