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Jean-Pierre P, Pulumati A, Kasheri E, Hirsch M, Nouri K. Lasers in the management of alopecia: a review of established therapies and advances in treatment. Lasers Med Sci 2024; 39:102. [PMID: 38630348 PMCID: PMC11023987 DOI: 10.1007/s10103-024-04054-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/11/2024] [Indexed: 04/19/2024]
Abstract
Alopecia, also known as hair loss, is a highly prevalent condition affecting millions of men and women in the United States and worldwide, making it one of the most common complaints by patients presenting to a dermatologist. The symptomology on the presentation of alopecia can be highly variable, ranging from diffuse thinning of hair, discrete and localized patches completely absent of hair, or noticing significant shedding when brushing and showering. Although alopecia does not have a direct negative health impact on patients, it is nonetheless a debilitating disease as it can profoundly impact an individual's self-image and psychosocial well-being. There are multiple treatment options available to patients with alopecia, and they are typically tailored to the patient's needs and preferences. The most common of these is the Food and Drug Administration-approved drugs for alopecia, minoxidil, and finasteride. However, both of these are known to be partially efficacious for all patients, so clinicians often use different modalities in conjunction with them, in particular laser-based therapies. This review article will provide a comprehensive assessment of lasers and other light therapies that may be used to manage the two most common types of alopecia: androgenetic alopecia and alopecia areata.
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Affiliation(s)
- Philippe Jean-Pierre
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, 1600 NW 10th Ave, 33136, Miami, FL, USA.
| | - Anika Pulumati
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Eli Kasheri
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, 1600 NW 10th Ave, 33136, Miami, FL, USA
| | - Melanie Hirsch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, 1600 NW 10th Ave, 33136, Miami, FL, USA
| | - Keyvan Nouri
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, 1600 NW 10th Ave, 33136, Miami, FL, USA
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Fatani MIA, Alkhalifah A, Alruwaili AFS, Alharbi AHS, Alharithy R, Khardaly AM, Almudaiheem HY, Al-Jedai A, Eshmawi MTY. Diagnosis and Management of Alopecia Areata: A Saudi Expert Consensus Statement (2023). Dermatol Ther (Heidelb) 2023; 13:2129-2151. [PMID: 37558830 PMCID: PMC10539276 DOI: 10.1007/s13555-023-00991-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
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.
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Affiliation(s)
| | - Abdullah Alkhalifah
- Department of Dermatology and Dermatologic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | | | | | - Ru'aa Alharithy
- Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- Department of Dermatology, Security Forces Hospital, Riyadh, Saudi Arabia
| | | | | | - Ahmed Al-Jedai
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
- College of Medicine and College of Pharmacy, AlFaisal University, Riyadh, Saudi Arabia
| | - Maysa Tariq Yousef Eshmawi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.
- Department of Dermatology, King Abdullah Medical Complex, Prince Nayef Street, Northern Abhor, 23816, Jeddah, Saudi Arabia.
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Meguid AMA, Ghazally A, Ahmed AM, Bakr RM. Fractional carbon dioxide laser alone and as an assisted drug delivery for treatment of alopecia areata: a clinical, dermoscopic and immunohistochemical study. Arch Dermatol Res 2023; 315:1675-1688. [PMID: 36809409 PMCID: PMC10338624 DOI: 10.1007/s00403-023-02565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 12/22/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023]
Abstract
Alopecia areata (AA) is a common cause of hair loss with no available universally successful treatment. Thus, new innovative treatments are urgently needed. This research aimed to evaluate the effectiveness of fractional carbon dioxide laser (FCL) alone or combined with triamcinolone acetonide (TA) solution, platelet-rich plasma (PRP), or vitamin D3 solution in treating AA. Sixty-four AA patients with 185 lesions were recruited and divided into four treatment groups. All patients received FCL either alone (group A, n = 19) or followed by topical TA (group B, n = 16) or PRP (group C, n = 15), or vitamin D3 solution (group D, n = 14). The response was assessed using Alopecia Areata Severity Index (AASI), MacDonald Hull and Norris grading, and trichoscopy. Histopathological features and immunohistochemical decorin expression were studied. All groups showed significant improvement in AASI compared to the baseline, with insignificant differences between them. Post-treatment, trichoscopic features of disease activity significantly decreased in all groups. Compared to control biopsies, both anagen follicles and decorin expression were significantly decreased in all pretreatment specimens. After treatment, all groups showed significantly increased anagen follicles and decorin expression compared to the baseline. Accordingly, FCL is an effective treatment for AA alone or combined with TA, PRP, or vitamin D3 solution. In AA, Decorin expression was downregulated, while enhanced expression following successful treatment occurred. This suggests the role of decorin in AA pathogenesis. However, further research is still recommended to clarify the exact role of decorin in AA pathogenesis and to investigate the therapeutic benefits of decorin-based therapy.
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Affiliation(s)
- Azza Mahfouz Abdel Meguid
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
| | - Alaa Ghazally
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
| | - Asmaa M. Ahmed
- Pathology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Radwa M. Bakr
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
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Ramos PM, Anzai A, Duque-Estrada B, Melo DF, Sternberg F, Santos LDN, Alves LD, Mulinari-Brenner F. Consensus on the treatment of alopecia areata - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:39-52. [PMID: 33183894 PMCID: PMC7772599 DOI: 10.1016/j.abd.2020.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/15/2020] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Paulo Müller Ramos
- Department of Dermatology and Radiotherapy, Universidade Estadual Paulista, Botucatu, SP, Brazil.
| | - Alessandra Anzai
- Department of Dermatology, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Bruna Duque-Estrada
- Centro de Estudos dos Cabelos, Instituto de Dermatologia Prof. Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Daniel Fernandes Melo
- Department of Dermatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Flavia Sternberg
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Leopoldo Duailibe Nogueira Santos
- Department of Medicine, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Dermatology and Allergology, Hospital do Servidor Público Municipal, São Paulo, SP, Brazil
| | - Lorena Dourado Alves
- Department of Tropical Medicine and Dermatology, Universidade Federal de Goiás, Goiânia, GO, Brazil
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Cuellar-Barboza A, Cardenas-de la Garza JA, Cruz-Gómez LG, Barboza-Quintana O, Flores-Gutiérrez JP, Gómez-Flores M, Welsh O, Ocampo-Candiani J, Herz-Ruelas ME. Local secretion of stress hormones increases in alopecia areata lesions after treatment with UVA-1 phototherapy. Exp Dermatol 2020; 29:259-264. [PMID: 31997403 DOI: 10.1111/exd.14077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 12/18/2022]
Abstract
Alopecia areata (AA) is an autoimmune disease of the hair follicle. Keratinocytes of the hair follicle generate an immunosuppressive environment by the local secretion of hormones of the hypothalamic-pituitary-adrenal axis of the skin (skin HPA analog). Our objective was to measure the local production of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), and α-melanocyte-stimulating hormone (α-MSH) in the scalp tissue of patients with AA before and after ultraviolet A1 (UVA-1) phototherapy to determine their role in the pathogenesis of AA and the effect of UVA-1 on the AA hormonal environment. This was a retrospective and descriptive study of skin samples from 22 patients with AA before and after UVA-1 treatment. We compared the changes in the local hormonal environment by measuring CRH, ACTH, type 2 melanocortin receptor (ACTH receptor) and α-MSH with immunohistochemical stains. The positivity of MSH was significantly higher (P = .037) in the post-treatment samples compared with the baseline value. ACTH was significantly higher in intensity (P = .032) in the post-treatment samples compared with the initial value. CRH was significantly higher in intensity (P = .013) in baseline samples compared with the final biopsies. The positivity of the ACTH receptor MC2R was not different between the two groups (P = .626). In AA, an interruption in the signalling of CRH could decrease the local concentration of ACTH and MSH, and consequently, the immunosuppressive effect of these hormones. This phenomenon is normalized in the skin treated with UVA-1. A defective signalling system in the cutaneous HPA axis may be involved in the pathogenesis of AA.
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Affiliation(s)
- Adrian Cuellar-Barboza
- Department of Dermatology, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. Jose Eleuterio Gonzalez", Monterrey, Mexico
| | | | - Luis Gerardo Cruz-Gómez
- Department of Dermatology, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. Jose Eleuterio Gonzalez", Monterrey, Mexico
| | - Oralia Barboza-Quintana
- Department of Pathology, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. Jose Eleuterio Gonzalez", Monterrey, Mexico
| | - Juan Pablo Flores-Gutiérrez
- Department of Pathology, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. Jose Eleuterio Gonzalez", Monterrey, Mexico
| | - Minerva Gómez-Flores
- Department of Dermatology, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. Jose Eleuterio Gonzalez", Monterrey, Mexico
| | - Oliverio Welsh
- Department of Dermatology, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. Jose Eleuterio Gonzalez", Monterrey, Mexico
| | - Jorge Ocampo-Candiani
- Department of Dermatology, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. Jose Eleuterio Gonzalez", Monterrey, Mexico
| | - Maira E Herz-Ruelas
- Department of Dermatology, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. Jose Eleuterio Gonzalez", Monterrey, Mexico
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Emerging Nonsteroid-Based Procedural Therapies for Alopecia Areata: A Systematic Review. Dermatol Surg 2020; 45:1484-1506. [PMID: 31403534 DOI: 10.1097/dss.0000000000002053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alopecia areata (AA) is a common form of patchy, nonscarring hair loss. Although intralesional steroid injections are currently the mainstay procedural therapy for AA, other nonsteroid-based procedural therapies, including platelet-rich plasma (PRP), ultraviolet radiation (UVR), and laser-based modalities, are emerging as practical options. OBJECTIVE To systematically review nonsteroid-based procedural therapies for AA and recapitulate the available clinical data. MATERIALS AND METHODS A systematic review of the literature was performed searching PubMed/MEDLINE databases identifying studies investigating PRP, UVR, and laser-based modalities for AA treatment. RESULTS Literature search yielded 644 articles encompassing PRP, UVR, and laser treatment modalities for AA. Of the 644 articles, 46 met inclusion criteria. Although numerous reports demonstrate strong potential for PRP, UVR, and laser modalities in treating AA, high-quality evidence supporting their efficacy is still lacking. CONCLUSION There is an abundance of evidence for nonsteroid-based procedural therapies in the treatment of AA. Randomized control trials comparing these treatment options head-to-head should be performed to better understand the true efficacy of these treatments.
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França K, Castillo D, Tchernev G, Lotti T. UVA-1 in the treatment of alopecia areata. Dermatol Ther 2017; 30. [PMID: 28834031 DOI: 10.1111/dth.12547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Katlein França
- Institute for Bioethics & Health Policy; Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, Miami, Florida.,Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida
| | - David Castillo
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida
| | - Georgi Tchernev
- Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior (MVR), Sofia, Bulgaria
| | - Torello Lotti
- Department of Dermatology, Universita degli Studi Guglielmo Marconi, Roma, Italy
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