Mishra, AditiKC, ShekharShrestha, ElishaPandey, ChandranshuKarn, Dharmendra2025-09-232025-09-232022https://hdl.handle.net/20.500.14572/2293Aditi Mishra Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal https://orcid.org/0000-0002-1758-2153 Shekhar KC Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal Elisha Shrestha Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal https://orcid.org/0000-0003-1337-7977 Chandranshu Pandey Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal Dharmendra Karn Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, NepalAbstract: Introduction: Alopecia areata is a T cell-mediated autoimmune disorder of hair follicles resulting in partial or total hair loss. Treatment of alopecia areata is difficult, and it has variable severity. Objectives: To compare the clinical efficacy and adverse clinical events of azathioprine versus methotrexate with steroid minipulse therapy in managing moderate to severe alopecia areata. Materials and Methods: Prospective non-blinded clinical trial conducted for 6 months in Department of Dermatology at Dhulikhel Hospital. Dermoscopic evidence of alopecia areata patients treated according to group assigned and effects and adverse event were noted. Results: There was a total of 36 patients enrolled. Twenty patients were in Group A (AZT+MPT) and 16 in group B (MTX+MPT). There was a significant improvement in SALT score at 6 months (Group A p-value: 0.03; group B p-value: 0.001). Treatment efficacy (percent scalp hair regrowth) in group A was 79.2%, and in group B was 89.01%. Conclusion: Both treatment regimens showed marked improvement with SALT score reduction; however, methotrexate with steroid minipulse therapy showed slightly higher treatment efficacy than azathioprine with steroid minipulse therapy.en-USAlopecia areataAzathioprineMethotrexateArticle