Comparative Evaluation of Efficacy and Safety of Topical Methotrexate With Tretinoin Versus Betamethasone With Tretinoin in Patients of Alopecia Areata: A Prospective Randomized Double-Blind Study

This study compared the efficacy and safety of topical methotrexate with tretinoin versus betamethasone with tretinoin in 80 patients with alopecia areata over 6 months. Patients were divided into two groups of 40, with one group using methotrexate and tretinoin and the other using betamethasone and tretinoin. Both treatments significantly reduced the mean severity of alopecia tool (SALT) scores, with methotrexate showing a slightly better response, though not statistically significant. The majority of patients in both groups achieved a high regrowth scale (RGS) score, with methotrexate showing a slightly higher percentage of RGS Grade 4. Mild adverse reactions were more common in the methotrexate group but resolved with minor treatment. The study concluded that topical methotrexate is more efficacious and equally safe as betamethasone, suggesting it as a first-line treatment for alopecia areata.