Comparative Efficacy of Topical Trichloroacetic Acid and Superficial Cryotherapy in Resistant Alopecia Areata: A Randomized Clinical Trial

Why clinicians should know about it

• Picked for Dermatology (top studies of the week, 20 September 2026): RCT comparing TCA vs cryotherapy for alopecia areata

Abstract

BACKGROUND: Alopecia areata (AA) is a frequent nonscarring alopecia affecting the body or scalp, distinguished by hair loss without clinical inflammatory indicators. OBJECTIVE: To compare the efficiency and safety of trichloroacetic acid (TCA), 35%, vs superficial cryotherapy in the treatment of resistant AA. METHODS: In a double-armed, single-blinded, randomized clinical trial, 32 patients with resistant AA were randomized into 2 groups of 16 patients each: superficial cryotherapy group and topical TCA group. The first group was treated with superficial cryotherapy administered by spraying liquid nitrogen for 15 seconds, followed by thawing, and repeated for 2 further cycles, every 2 weeks for 3 months (6 sessions). The second group was treated with topical TCA performed once monthly for 3 months (3 sessions). RESULTS: No statistically significant variance was discovered among the examined groups according to Severity of Alopecia Tool (SALT) score before treatment (P=0.93). Following treatment, a SALT score reduction from 10.93±3.90 to 7.28±3.27 was demonstrated among the cryotherapy group and from 10.81±4.91 to 4.46±2.88 in the TCA group. A more significant reduction in alopecia severity (P<0.01) was discovered after treatment among the TCA group. CONCLUSION: We have demonstrated the efficacy of both treatments with a more significant result favoring TCA. Considering that it is less painful and easier to perform, superficial cryotherapy is especially worthy of application to patients with mild AA and with stable course who have difficulty with conventional treatments.

Abstract as published, via PubMed.