Evaluation of the Efficacy and Safety of Oral Roflumilast Versus Intralesional Corticosteroids Injection (ILCs) in the Treatment of Alopecia Areata

Inclusion Criteria: * Patients with mild to moderate patchy alopecia areata as assessed by SALT score (S1: 1-24% hair loss (limited); S2: 25-49% hair loss (moderate)) * Patients with patchy alopecia areata with viable hair follicles by trichoscopy. * Patients of both genders aged \>18 years. * Patients able and willing to provide informed consent. Exclusion Criteria: * Patients with other types of AA (surface area \>50%, alopecia totalis, alopecia universalis and ophiasis). * Patients less than 18 years old. * Patients receiving systemic treatment relevant to AA or biologics, phototherapy, or topical treatment within 4 weeks before enrollment into the study. * Patients with a history of/ or existing scalp skin diseases apart from AA, such as eczema, seborrheic dermatitis, psoriasis, scalp infections, or skin cancer. * Pregnant and lactating females. * Patients with a history of other inflammatory skin conditions * History of hypersensitivity to roflumilast or its components. * History of severe anxiety or depression (Gupta, 2012) * Patients with history of bleeding disorders or on anticoagulant medications, * Patients with active infection at the local site, patients with keloidal tendency, and patients with low pain threshold.