Alternating PRP, Steroid Injections Lower SALT Scores in Pediatric AA

A 10-year-old boy with severe, rapidly progressive alopecia areata (AA) had his Severity of Alopecia Tool (SALT) score decrease from 89.4% to 0% after 162 days of alternating platelet-rich plasma (PRP) and intralesional corticosteroid injections, according to a case report presented as a poster at the 2026 Skin of Color Update in New York, New York.¹

Pediatric AA can be difficult to treat because of its unpredictable course and high recurrence rates, and standard first-line therapies often fail in severe cases, according to the investigators from the Department of Dermatology and Venereology at Udayana University and Ngoerah Hospital in Bali, Indonesia. They noted that combining the regenerative properties of PRP with the anti-inflammatory effects of intralesional corticosteroids may enhance hair regrowth, but clinical documentation of this approach in pediatric patients remains limited. When first-line therapies fail, aggressive, multimodal interventions are required while minimizing adverse events in patients with skin of color, they wrote. The case report aimed to evaluate the efficacy and safety of this combined approach in a pediatric Asian patient with severe AA of unknown etiology.

Pediatric Alopecia Areata Case Presentation

The patient, a Balinese boy, presented with extensive hair loss that had developed over 3 weeks and had not responded to prior oral and topical corticosteroids. Trichoscopy showed exclamation mark hairs and black dots. Laboratory testing showed a positive antinuclear antibody (ANA) immunofluorescence test (1:100, fine speckled pattern), a negative ANA profile, and normal complement C3 levels. The etiology of his AA was described as unknown. His disease progressed aggressively, and his SALT score worsened from 65% at initial presentation to 89.4% at peak severity, corresponding to an Alopecia Areata Investigator Global Assessment (AA-IGA) grade of 4, or very severe.

Alternating PRP and Intralesional Triamcinolone Protocol

The patient received intradermal PRP alternating with intralesional triamcinolone acetonide 5 mg/mL every 14 days. Over 162 days, he completed 6 PRP sessions and 6 intralesional corticosteroid sessions. Clinical progress was documented with photographs of the frontal, lateral, vertex, and occipital scalp at initial presentation, at peak severity, and after treatment.

After 162 days of treatment, the patient showed marked clinical improvement, with his SALT score decreasing from 89.4% to 0%. The regimen was well tolerated, and no localized skin atrophy, pigmentary changes, folliculitis, or systemic adverse effects were reported. The investigators concluded that in this patient, alternating PRP and intralesional corticosteroid injections were a highly effective and safe treatment for severe, rapidly progressive pediatric AA. They wrote that the reduction in SALT score points to the potential synergy of combining immunomodulatory and regenerative agents and that the approach may be a valuable strategy for severe pediatric hair loss in skin of color, although further standardized clinical trials are needed to validate the results. The investigators declared no conflicts of interest.

Evidence on PRP in Alopecia Areata

AA is a chronic autoimmune condition that can substantially reduce quality of life, and triamcinolone acetonide is the first-line treatment for patchy disease, although its effectiveness varies, according to a 2022 systematic review and meta-analysis of randomized clinical trials comparing PRP with triamcinolone acetonide or placebo. Of 2,747 articles identified, 4 studies were eligible for quantitative analysis, with change in SALT score as the primary outcome. The analysis found no statistically significant difference in SALT score change between PRP and triamcinolone acetonide (mean difference, −2.04; 95% CI, −4.72 to 0.65; P = .14), with heterogeneity between studies (I² = 80.4%). Those authors described PRP as a promising steroid-free option and called for additional high-quality randomized trials.²

References

1. Kesuma NMTS, Rusyati LMM, Winaya KK. Alternating platelet-rich plasma and intralesional corticosteroid therapy in severe pediatric alopecia areata: a case report of an Asian patient. Poster presented at: Skin of Color Update 2026; October 9-11, 2026; New York, NY.
2. Meznerics FA, Illés K, Dembrovszky F, et al. Platelet-rich plasma in alopecia areata—a steroid-free treatment modality: a systematic review and meta-analysis of randomized clinical trials. Biomedicines. 2022;10(8):1829. doi:10.3390/biomedicines10081829