A review on laser and light-based therapies for alopecia areata

A retrospective analysis of disease epidemiology, comorbidities, treatment patterns, and healthcare resource utilization of alopecia areata in the United Arab Emirates using claims database

Alopecia areata (AA) is an autoimmune disorder that manifests as nonscarring hair loss and imposes a substantial disease burden. The current study, using an e-claims database, assesses the disease burden, comorbidities, treatment patterns, specialties involved in the diagnosis of AA, healthcare resource utilization (HCRU), and associated costs in privately insured patients with AA in Dubai, United Arab Emirates. The retrospective longitudinal secondary study was conducted using Dubai Real-World Database e-claims data during 01 January 2014 to 30 June 2022. Patients with at least one diagnosis claim of AA during the index period (01 January 2015-30 June 2021) with continuous enrollment (one or more AA/non-AA claim in the post-index period) were included in the analysis. The patients were stratified into subcohorts based on diagnosis code and treatment patterns, as mild, moderate-to-severe, and others. Demographics, comorbidities, treatment patterns, specialists visited, and HCRU were assessed. The study included 11 851 patients with AA (mean age: mild: 37 years; moderate-to-severe: 36 years), with a male predominance (mild: 77.6%; moderate-to-severe: 60.8%). The most prevalent comorbidities in the moderate-to-severe AA subcohort were autoimmune and T-helper 2-mediated immune disorders, including contact dermatitis and eczema (62.1%), atopic dermatitis (36.1%), and asthma (36.1%). Most patients consulted dermatologists for treatment advice (mild AA: 87.4%; moderate-to-severe AA: 47.7%) and, notably, within 1 day of AA diagnosis. Topical steroids were frequently prescribed across cohorts, regardless of disease severity. Analysis of comorbidities among patients with AA indicated an additional HCRU burden among these subsets of patients. The median disease-specific HCRU cost was higher for psychological comorbidities versus autoimmune and T-helper 2-mediated immune disorders (US $224.99 vs US $103.70). There is a substantial disease and economic burden in patients with AA and associated comorbid conditions; therefore, investing in novel therapies that target the underlying autoimmune pathway may address the gap in effective management of AA.

Diagnosis and Management of Alopecia Areata: A Saudi Expert Consensus Statement (2023)

Alopecia areata (AA) is a complex autoimmune disease manifesting as a chronic inflammatory disease characterized by non-scarring patches of hair loss over the face, scalp, and body. Several treatments have been proposed for AA, but none are curative nor achieve a state of remission. The present consensus statement aims to present the evidence- and experience-based recommendations on the diagnosis and management of AA in Saudi Arabia. The Ministry of Health in Saudi Arabia has opted to initiate a meeting of a multidisciplinary group to discuss and concede on this topic. Eight dermatology experts and clinical pharmacists convened in eight consensus meetings. All content presented in this document was agreed upon by this working group, including diagnosis and severity assessment, prognostic indicators, and therapeutic options for AA. Special consideration was given to special patient populations including pediatric patients and patients with less frequent presentations of AA. Updates of the current recommendations will take place as new evidence evolves in the treatment of AA.

Effectiveness of QR678 and QR678 Neo® with intralesional corticosteroid vs. intralesional corticosteroid alone in the treatment of alopecia areata -A randomized, comparative, prospective study

BACKGROUND

Alopecia areata (AA) is an inflammatory disorder, marked by chronic, persistent, and patchy loss of hair. At present intralesional/topical corticosteroids, Minoxidil solution, and topical immune-therapies are used for treatment. Though all these have side effects and high rate of relapse. As QR678 Neo^® is proved to be effective in hair regrowth in male and female pattern hair loss, the aim of the study is to compare the efficacy of QR678 Neo^® with intralesional steroid therapy vs. intralesional steroid alone in the treatment of AA of scalp in men and women.

MATERIALS AND METHODS

A total of 20 participants in age group of 20-50 years with nonscarring patchy hair loss were chosen for the study. Patients were arbitrarily divided into two groups (Group A-intralesional steroid with placebo and Group B-intralesional steroid with QR678 Neo^® ). All the participants were evaluated at baseline, 3 months and 6 months with standard global photography, dermoscopic assessment, and self-evaluation questionnaire at the end of study.

RESULT

Marked improvement was seen in the global assessment score after 6 months (mean- 6.6 SALT) as compared to baseline (38.5 SALT score) in group B. There was significant reduction of black dots, yellow dots, broken hairs, and tapered hair at 6 months on video dermoscopic examination in group B. Also, higher satisfaction was experienced with the treatment in group B patients.

CONCLUSION

QR678 Neo^® in combination with intralesional steroids therapy proved to be significantly beneficial, efficient, and can be considered as safer treatment option for alopecia areata.

Treatment of pediatric alopecia areata: A systematic review

Background:

Alopecia areata (AA) is an autoimmune, nonscarring hair loss disorder with slightly greater prevalence in children than adults. Various treatment modalities exist; however, their evidence in pediatric AA patients is lacking.

Objective:

To evaluate the evidence of current treatment modalities for pediatric AA.

Methods:

We conducted a systematic review on the PubMed database in October 2019 for all published articles involving patients <18 years old. Articles discussing AA treatment in pediatric patients were included, as were articles discussing both pediatric and adult patients, if data on individual pediatric patients were available.

Results:

Inclusion criteria were met by 122 total reports discussing 1032 patients. Reports consisted of 2 randomized controlled trials, 4 prospective comparative cohorts, 83 case series, 2 case-control studies, and 31 case reports. Included articles assessed the use of aloe, apremilast, anthralin, anti-interferon gamma antibodies, botulinum toxin, corticosteroids, contact immunotherapies, cryotherapy, hydroxychloroquine, hypnotherapy, imiquimod, Janus kinase inhibitors, laser and light therapy, methotrexate, minoxidil, phototherapy, psychotherapy, prostaglandin analogs, sulfasalazine, topical calcineurin inhibitors, topical nitrogen mustard, and ustekinumab.

Limitations:

English-only articles with full texts were used. Manuscripts with adult and pediatric data were only incorporated if individual-level data for pediatric patients were provided. No meta-analysis was performed.

Conclusion:

Topical corticosteroids are the preferred first-line treatment for pediatric AA, as they hold the highest level of evidence, followed by contact immunotherapy. More clinical trials and comparative studies are needed to further guide management of pediatric AA and to promote the potential use of pre-existing, low-cost, and novel therapies, including Janus kinase inhibitors.

Photobiomodulation for the management of hair loss

Photobiomodulation, otherwise known as low-level laser (or light) therapy, is an emerging modality for the management of hair loss. Several randomized trials have demonstrated that it is safe and potentially effective on its own or in combination with standard therapies. These devices come in many forms including wearable caps or helmets that afford hands-free and discreet use. Models with light-emitting diodes (LEDs) are less expensive compared to laser-based devices and do not require laser safety considerations, thus facilitating ease of home use. Limitations include cost of the unit, risk of information bias, and lack of standardized protocols. Finally, as with any hair loss treatment, patients' expectations with regards to therapeutic outcomes must be managed.

Consensus on the treatment of alopecia areata - Brazilian Society of Dermatology

BACKGROUND

Alopecia areata is a highly frequent disease with an impact on quality of life and several treatment options with little clinical confirmatory evidence.

OBJECTIVE

To disseminate the recommendations of Brazilian dermatologists with expertise in the treatment of alopecia areata.

METHODS

Eight specialists with expertise in alopecia areata from different university centers were appointed by the Brazilian Society of Dermatology to reach a consensus on its treatment. Based on the adapted DELPHI methodology, the relevant elements were considered; then, an analysis of recent literature was carried out and the consensus was written down. Consensus on the management of alopecia areata was defined with the approval of at least 70% of the panel.

RESULTS/CONCLUSIONS

Intralesional injectable corticotherapy was considered the first option for localized disease in adults. In extensive cases with signs of activity, systemic corticosteroid therapy should be considered and can be used together with immunosuppressants (corticosteroid-sparing agents). The use of an immunosensitizer (diphencyprone) is an option for stable long-term cases. Evaluation of side effects is as important as the rate of hair regrowth.

Treatment of alopecia areata with 2940-nm fractional erbium:yttrium-aluminum-garnet laser

Various laser therapies have been used for the treatment of alopecia areata (AA). Enhanced hair regrowth was reported with the use of ablative fractional 2940-nm erbium:yttrium-aluminum-garnet (Er:YAG) laser in a murine model. However, clinical effectiveness of fractional Er:YAG laser for hair disorders has not been investigated in human studies. The aim of our study was to assess the effectiveness of 2940-nm fractional Er:YAG laser in the treatment of chronic AA that is unresponsive to conventional therapies. Twenty-five AA patients underwent three sessions, each 4 to 6 weeks apart, of fractional Er:YAG laser. Clinical evaluation was done at baseline and 1 month post-treatment (follow-up) by photographic assessment. Subjective evaluation by patient satisfaction score was also performed. Photographic evaluation of the patients revealed a mean percent change in SALT score of 17.4 ± 3.5% at follow-up. A total of 16 patients who were treated for patchy AA of the scalp showed 27.8 ± 31.3% regrowth. Five patients who were treated for AA of the beard had 39 ± 34.2% regrowth. Fractional Er:YAG laser might be a therapeutic alternative for patients with patchy AA of the scalp and beard that is unresponsive to conventional therapies.

Laser Light Therapy in Inflammatory, Musculoskeletal, and Autoimmune Disease

PURPOSE OF REVIEW

The goal of this review is to summarize the field to date and to discuss strengths and limitations of low-level laser (light) therapy (LLLT) for the future investigation as a treatment of inflammatory disease.

RECENT FINDINGS

LLLT is a promising therapeutic, particularly for those diseases of skin and joints because they are most accessible to treatment. Indeed, the known mechanisms of LLLT support its use for anti-inflammatory purposes, as well as stimulation of tissue growth and repair. Although the standard of care for the majority of inflammatory diseases is immunosuppressive agents such as corticosteroids with undesirable toxicities, LLLT offers a unique approach by being non-invasive and incurring minimal side effects. It is also relatively inexpensive and accessible and even has the possibility to be patient directed at home. There is evidence that LLLT is able to modulate the immune system at the skin and joint, and it has been shown to be efficacious in humans by affecting bacterial colonization as it may pertain to chronic rhinosinusitis. However, there is variability in the methods of laser application as well as a lack of evidence for laser type, dose-ranging studies, and wavelength selection that create barriers to the implementation of LLLT without further more rigorous and standardized study. The heterogeneity makes it difficult to draw strong conclusions about the efficacy of LLLT and its mechanisms.

Alopecia areata

Alopecia areata is an autoimmune disorder characterized by transient, non-scarring hair loss and preservation of the hair follicle. Hair loss can take many forms ranging from loss in well-defined patches to diffuse or total hair loss, which can affect all hair-bearing sites. Patchy alopecia areata affecting the scalp is the most common type. Alopecia areata affects nearly 2% of the general population at some point during their lifetime. Skin biopsies of affected skin show a lymphocytic infiltrate in and around the bulb or the lower part of the hair follicle in the anagen (hair growth) phase. A breakdown of immune privilege of the hair follicle is thought to be an important driver of alopecia areata. Genetic studies in patients and mouse models have shown that alopecia areata is a complex, polygenic disease. Several genetic susceptibility loci were identified to be associated with signalling pathways that are important to hair follicle cycling and development. Alopecia areata is usually diagnosed based on clinical manifestations, but dermoscopy and histopathology can be helpful. Alopecia areata is difficult to manage medically, but recent advances in understanding the molecular mechanisms have revealed new treatments and the possibility of remission in the near future.