Methotrexate Microinfusion Improves Symptoms in Frontal Fibrosing Alopecia

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Application of methotrexate (MTX) through a microinfusion technique known as MMP is well-tolerated and effective in improving symptoms of frontal fibrosing alopecia, new findings suggest.1

These findings resulted from research authored by a team of investigators such as Tatiane Elen de Souza Pitlovanciv, from the department of clinical medicine at the Federal University of Paraná in Brazil. Pitlovanciv et al. highlighted that MTX, when injected through the MMP technique, had shown positive results in treating psoriasis.2

“The drug when injected percutaneously has potent local effect and its inactivation due to first hepatic passage is prevented,” Pitlovanciv and colleagues wrote.1 “Considering that the treatment of [frontal fibrosing alopecia] is challenging, this study aims to evaluate the efficacy and safety of MTX infusion through the MMP technique on the scalp through a prospective controlled trial.”

The investigative team involved 18 subjects in this prospective, controlled clinical analysis, looking specifically at individuals with diagnoses of frontal fibrosing alopecia. Their work was conducted at a single dermatology center with approval from the local research ethics committee. Those who qualified for inclusion would be over the age of 18 years and have a confirmed diagnosis of frontal fibrosing alopecia, established through a clinical assessment, trichoscopy, and a biopsy.

In terms of exclusion criteria, individuals could not have chronic hepatitis, abnormal liver function, renal impairment, hemolytic anemia, or be currently pregnant during the evaluation. Among their other exclusion criteria, the investigators required that those taking part not have treatment with corticosteroid injections, systemic MTX, or microinfusion therapy within the prior 4-month period.

The scalp area, prior to treatment, was targeted by the research team for injection were inspected by the team and disinfected via 0.2% chlorhexidine. There were 3 MTX sessions using 1 mL of a 50 mg/2 mL solution, with administration occurring through the use of the aforementioned microneedling with medication (MMP) technique.

A single dermatologist was asked to conduct all procedures, applying the MTX exclusively to the right side of participants' alopecia-affected scalp region. The left side of this area remained untreated and served the study as a control. The investigators implemented a Cheyenne MMP device for the procedure, fitted with a Magnum 23 tip, and spaced their treatments 30 days apart.

In the 30 days after the final session, the team looked into satisfaction among participants using a questionnaire that evaluated any shifts in alopecia area size, hair density, hair thickness, and hair shedding. The survey also highlighted any local or systemic symptoms that subjects experienced from the MMP treatment.

Overall, the analysis's findings demonstrated that there had been a significant reduction in the frontal-glabella and frontal temporoparietal measurements on the MTX-treated side of patients' scalps.1 Conversely, the investigative team reported that progression of frontal fibrosing alopecia had been noted on the untreated region.

Improvements in pruritus as well as scalp flaking were also highlighted in the study, although no notable change was demonstrated in hair shedding or local redness within the team's findings.

Dermoscopic image analyses and LPPAI (Lichen Planopilaris Activity Index) scores were both shown not to have any meaningful differences. Nevertheless, the investigators pointed to their finding that approximately 95% of those taking part in the study reported being satisfied or very satisfied with the post-MTX outcomes.1 Additionally, no abnormalities were detected by the investigators in their laboratory test results.

“...the use of MTX in drug delivery through MMP showed the ability to reduce symptoms and to avoid progression of [frontal fibrosing alopecia],” they concluded.1 “Trichoscopy and LPPAI were not good instruments to evaluate treatment response but the frontal glabella and bilateral frontal temporoparietal measurements were satisfactory. The procedure was safe and well tolerated offering a new option for treatment of [frontal fibrosing alopecia] patients.”

References

1. Pitlovanciv TES, Skare TL, Medeiros KB, Fabri AB. Efficacy of Methotrexate Microinfusion in Scalp Lesions of Patients with Frontal Fibrosing Alopecia: A Prospective Controlled Trial. Skin Appendage Disord. 2025 Apr;11(2):151-158. doi: 10.1159/000540846. Epub 2024 Sep 10. PMID: 40176992; PMCID: PMC11961090.

2. Okita AL, Arbache, S, Roth, DMP, Souza, LG, Colferai, MMT, Steiner, D. Tratamento de psoríase vulgar pela microinfusão de medicamentos na pele (MMP®) usando ciclosporina e metotrexato. 2018;10(1):1.