Comparative study of intralesional steroid injection and cryotherapy in alopecia areata

Guidelines for the Management of Patients with Alopecia Areata in Korea: Part I Topical and Device-based Treatment

BACKGROUND

Alopecia areata (AA) is a chronic disease with an unpredictable disease course and severe psychological impact.

OBJECTIVE

To provide evidence- and consensus-based insights regarding the treatment of patients with AA in Korea.

METHODS

We searched for relevant studies on the topical and device-based treatment of AA in the literature from inception until May 2021. Evidence-based recommendations were also prepared. The evidence for each statement was graded and classified according to the strength of the recommendations. Hair experts from the Korean Hair Research Society (KHRS) voted on the statements, and an agreement of 75% or greater was considered as consensus.

RESULTS

Currently, there remains a scarcity of topical treatments, which is supported by robust evidence from a number of high-quality randomized controlled trials. Current evidence supports the efficacy of topical corticosteroids, corticosteroid intralesional injection, and contact immunotherapy in AA patients. Topical corticosteroids and contact immunotherapy are recommended for pediatric AA. A consensus was achieved in 6 out of 14 (42.8%), and 1 out of 5 (20.0%) statements pertaining to topical and device-based treatments in AA, respectively. The expert consensus was from a single country, and the study may not cover all the treatments used.

CONCLUSION

The present study provides up-to-date, evidence-based treatment guidelines for AA based on the consensus reached among experts after considering regional healthcare circumstances, adding diversity to the previous guidelines.

IADVL SIG Pediatric Dermatology (Academy) Recommendations on Childhood Alopecia Areata

Alopecia areata (AA) is a chronic inflammatory disease characterized by nonscarring alopecia. In contrast to adult onset AA, the epidemiology, clinical characteristics, and therapy of childhood AA are less explored. This study aims at providing recommendations for the management of childhood AA. The special interest group (SIG) in pediatric dermatology under the Indian Association of Dermatology, Venereology and Leprosy (IADVL) conducted online meetings from February 2021 to September 2021, intending to identify the critical aspects in the diagnosis and treatment of AA. The classification, diagnosis, and tools for assessment of disease activity of childhood AA have been described in this study, along with recommendations for topical and systemic therapy, including newer therapeutic options.

Comparative study of the use of fractional co2 laser versus the use of Liquid Nitrogen Cryotherapy In the treatment of Alopecia Areata in a sample of the Egyptian population

BACKGROUND

Alopecia areata (AA) is an autoimmune disease that is represented as patches of hair loss, FractionalCo2 laser and Cryotherapy are used to stimulate hair growth in patients of AA.

AIM

evaluation of fractional co2 laser effect versus liquid nitrogen cryotherapy in the treatment of Alopecia Areata.

METHODS

Eighty patients presented with patches of AA. The first group consisted of 40 patients was treated with fractional co2 laser, the second group also 40 patients was treated with cryotherapy. The efficacy of the treatment was statistically evaluated.

RESULTS

A positive therapeutic response was noted in most patients By trichoscopy at the end of treatment, there was a decrease in exclamation mark hairs, yellow dots, black dots, broken hairs, and an increase in short vellus hair and circle hair of patients compared to baseline and control. No serious side effects were seen.

CONCLUSION

Fractional co2 laser and Liquid nitrogen cryotherapy is considered a promising, safe, and effective treatment modality with the better result with co2 laser.

Alopecia areata - Current understanding and management

Alopecia areata (AA) is a chronic, immune-mediated disease characterized by acute or chronic non-scarring hair loss, with a heterogeneity in clinical manifestations ranging from patchy hair loss to complete scalp and body hair loss. An overview of the up-to-date pathophysiology and the underlying signaling pathways involved in AA together with diagnostic and therapeutic recommendations will be provided. Current treatments, including topical, systemic and injectable interventions show varying response and frequent relapses reflecting the unmet clinical need. Thus, the new emerging concepts and therapeutic approaches, including Janus kinase inhibitors are eagerly awaited. Traditional and emerging therapies of AA will be discussed, in order to provide physicians with guidance for AA management. Since the latter is so challenging and often tends to take a chronic course, it can have an enormous psychosocial burden on patients, compromising their quality of life and often causing depression and anxiety. Therefore, the psychosocial aspects of the disease need to be evaluated and addressed, in order to implement appropriate psychological support when needed.

Characterizing the willingness to undergo treatment in patients with alopecia areata

Alopecia areata is an autoimmune disease that results in partial or total balding of the scalp and/or body. Treatments available are minimally effective, have severe side effects, and are often painful. Given these burdens, patients may not feel undergoing treatment is worthwhile. The purpose of this study is to characterize the willingness of patients with alopecia areata to undergo treatment. We found that few patients are willing to undergo treatment at the risk of severe health side effects. The most acceptable form of treatment administration was topical and the least acceptable was injection at the site of hair loss. A majority of patients would only undergo treatment for hair growth that is cosmetically acceptable and the most important site of hair regrowth was the scalp. The willingness to undergo treatment differed significantly by gender, age, time since disease onset, and disease severity. This study offers insight into the preferences of patients with alopecia areata and characteristics that would make treatment widely acceptable. Institutions conducting research on treatment for alopecia areata can use the results of this study to better understand the needs of their target population.

Association between alopecia areata and thyroid dysfunction

Alopecia Areata is an inflammatory and T cell-mediated autoimmune reaction against unknown autoantigen of hair follicles characterized by patchy, non-scarring loss of hair follicles in the anagen phase. Although its etiology is minimally understood, genetic susceptibility, autoimmunity and stress are thought to be causative factors. It occurs in episodic and recurrent patterns with an incidence rate of 0.1-0.2% in the general population and 7-30 cases per 1000 dermatological patients with a lifetime risk of 1.7%. The lesions can be single and self-limiting or may be widespread. Autoimmune disorders such as Hashimoto's thyroiditis, Vitiligo, celiac disease, diabetes mellitus, psoriasis ad lupus erythematosus were observed as an associated comorbid disorder in AA patients, but hypothyroidism and Vitiligo have the strongest association. Its clinical course is unpredictable and shows no significant predilection to age, gender or race. AA is a heterogeneous variant of alopecia and has clinical types such as patchy alopecia, alopecia reticularis and alopecia totalis. Various epidemiological reports demonstrate an increased frequency of AA in thyroid disease patients. Contemporary research has shed spotlight on circulating auto-reactive cells in evolution of AA, which may play a role in ultimately linking these diseases. Comprehension of complex interplay between autoantigens and immune cells is still evolving. The present study will explore this association of Alopecia Areata in patients with thyroid dysfunction. This correlation was studied briefly with literature available in the medical database such as PubMed and Google Scholar.

Superficial cryotherapy using dimethyl ether and propane mixture versus microneedling in the treatment of alopecia areata: A prospective single-blinded randomized clinical trial

To verify and compare the therapeutic efficacy and safety of superficial cryotherapy using dimethyl ether and propane (DMEP) mixture vs. microneedling in the treatment of mild scalp alopecia areata (AA). In a prospective randomized single-blinded clinical trial, 80 patients with clinically evident scalp mild AA were randomly assigned into two groups of 40 patients each. Group (1) was treated by superficial cryotherapy using DMEP in three freeze-thaw cycles of 5 s each. Group (2) was treated by microneedling. Both groups were treated every 2 weeks for 6 sessions and followed up for 3 months after the last session. Patients were assessed by photographic documentation, trichoscopic evaluation, severity of alopecia tool (SALT) score, and alopecia areata symptom impact scale (AASIS). An excellent response was achieved in 15 (37.5%) of group (1) compared with 14 (35%) of group (2) patients, while a good response was achieved in 23 (57.5%) of group (1) compared with 21 (52.5%) of group (1) patients, with a statistically insignificant difference. The mean SALT score change percentage was a statistically significantly higher in group (2) patients. The mean AASIS change percentage was higher in group (1) patients, but this was a statistically insignificant. In both groups, the mean numbers of trichoscopic signs of AA significantly decreased from baseline to the end of follow-up period. Both therapeutic modalities were well-tolerated, with no recurrence after the follow-up period. Both superficial cryotherapy using DMEP mixture, and microneedling are simple, effective, and safe therapeutic options for mild scalp AA, however, microneedling showed higher efficacy.

Candida antigen immunotherapy versus steroid in the treatment of alopecia areata

Alopecia areata (AA) is an autoimmune hair follicle disorder that is challenging to treat. Although there are multiple topical immunotherapeutic agents, their side effects limit their use. Candida antigen can serve as another immunotherapeutic treatment, with an easier application and fewer side effects. To evaluate the efficacy of Candida antigen versus intralesional steroids for the treatment of AA. About 48 adult patients with AA were divided into two groups. The Candida group included 24 patients who were injected monthly with 0.1 mL of Candida albicans antigen in one patch of alopecia, and the intralesional corticosteroid group included 24 patients who were injected monthly with 0.1 mL of triamcinolone acetonide, as a control group, in all alopecia patches. After 5 months, there was a highly significant decrease in the severity of AA in both groups with no significant difference between them. In the Candida group, 8 patients showed complete hair regrowth and 9 patients showed partial regrowth. Side effects were mild and transient such as pain during injection, which was significantly lower in the Candida group than in the corticosteroid group. Intralesional Candida antigen is a promising effective treatment for AA with differing severities.

Comparative Evaluation of Therapeutic Efficacy of Intralesional Injection of Triamcinolone Acetonide versus Intralesional Autologous Platelet-rich Plasma Injection in Alopecia Areata

Context:

Alopecia areata is a chronic non-scarring alopecia that involves scalp and/or body. Corticosteroids are the most popular drugs for its treatment.

Aim:

The aim of the study was to evaluate the therapeutic efficacy of intralesional injection of triamcinolone acetonide and platelet-rich plasma (PRP) in alopecia areata and to compare the efficacy of these modalities in alopecia areata.

Settings and Design:

This was a randomized controlled comparative study.

Subjects and Methods:

Forty patients were enrolled from the outpatient department and divided into two groups of 20 patients each. Group A and B randomly received intradermal triamcinolone acetonide suspension (10 mg/mL) and PRP, respectively, into the lesion using an insulin syringe in multiple 0.1 mL injections 1cm apart. The injections were repeated every 3 weeks till 12 weeks. The patients were evaluated by Severity of Alopecia Tool (SALT) score and photographically every 3 weeks till the end of 12 weeks and then at the end of 6 months. Statistical analysis used descriptive analysis along with Pearson chi-square test or Fisher exact test, paired samples, and independent samples t test or their nonparametric analogs for continuous variables.

Results:

The reduction in SALT score at each visit with respect to baseline was greater in the triamcinolone group as compared to PRP group. This signifies greater effect of triamcinolone in alopecia areata. Around 50% patients in triamcinolone group and 5% patients in PRP group showed grade V improvement. Pain during intralesional injection was higher in the PRP group.

Conclusion:

Both intralesional triamcinolone and PRP were found to be efficacious in alopecia areata but the latter produced lesser improvement.

Comparative study between fractional carbon dioxide laser vs intralesional steroid injection in treatment of alopecia areata

Few studies have reported Fractional Carbon Dioxide (FCO2) laser use in treating alopecia areata (AA), yet, effectiveness of this therapy has not been comparatively analyzed. To assess efficacy and safety of FCO2 laser in comparison to traditional intralesional corticosteroids injection (ILCs) in treatment of AA. This study included 20 patients with at least two patches of AA. Patients were subjected to history taking, general, dermatological and folliscopic examination. One patch was treated by FCO2 laser every 2 weeks for 3 to 6 sessions, while the other treated with intradermal injection of Triamcinolone Acetonide monthly for three sessions maximally. Evaluation of treatment response was done by physician clinical assessment using Mean Improvement Score (MISP), patient satisfaction and folliscopic examination measuring hair density (hair/cm² ) before each session, 1 month and 3 months after end of sessions. The obtained data were tabulated and statistically analyzed. There was a highly significant improvement with FCO2 laser rather than ILCs 3 months after last session according to MISP, patient satisfaction and hair density without serious side effects or relapse. FCO2 laser could be a better therapeutic alternative for treating AA in comparison to traditional ILCs.

Emerging Unconventional Therapies for Alopecia Areata

Alopecia areata is a prevalent autoimmune skin disease with no cure or indicated treatment options. In the absence of an approved treatment, some patients are eager to try unconventional therapies, despite the very limited research evaluating their safety and efficacy. Recently emerging unconventional therapies for alopecia areata discussed include antihistamines, cryotherapy, and low-dose naltrexone.

Use of adapalene in alopecia areata: Efficacy and safety of mometasone furoate 0.1% cream versus combination of mometasone furoate 0.1% cream and adapalene 0.1% gel in alopecia areata

Alopecia areata (AA) is an autoimmune disease characterized by non-cicatricial hair loss. No definitive therapy currently exists for AA. To compared the efficacy and safety of the mometasone furoate 0.1% cream alone with the mometasone furoate 0.1% cream plus adapalene 0.1% gel in treatment of AA. Twenty patients with AA and with mean age of 27.4 ± 9.2 years were enrolled. Patches with a diameter of < 5 cm were treated with mometasone furate 0.1% cream (M), and patches with a diameter of ≥5 cm were treated with mometasone furate 0.1% cream plus adapalene 0.1% gel (M + D) for a period of 12 weeks. Hair regrowth was evaluated using a Re-growth score (RGS). Mean RGSs of M + D group were higher than M group for 4th week (2.60 vs. 1.45); 8th week (3.85 vs. 2.40) and 12th week (4.40 vs. 3.30). Mean percentages of hair re-growth in M + D group were statistically higher than M group for 4th (50.2% vs. 23.5%), 8th (78.5% vs. 50.7%), and 12th week (90.5% vs. 71%). Study revealed the efficacy and safety of adapalene and mometasone furoate combination in AA. Adapalene can be used as a new therapeutic modality in AA.

Liquid Nitrogen Cryotherapy in Recalcitrant Alopecia Areata: A Study of 11 Patients

CONTEXT

Recalcitrant alopecia areata (AA) is not uncommon in clinical practice. In certain patients, treatment failures are known with almost every conventional therapy either singly or in combination.

AIMS

To study the efficacy of liquid nitrogen (LN) cryotherapy in patients with recalcitrant AA.

SUBJECTS AND METHODS

We present series of eleven patients of recalcitrant AA, who consulted us after getting no response to various modalities of treatment for 6 months. We treated them with LN cryotherapy every 2 weeks till significant hair regrowth or maximum five sittings (at 0, 2, 4, 6, and 8 weeks) whichever was earlier. Inclusion and exclusion criteria were applied. Each patient was counseled and a written consent was taken. Every session consisted of dual freeze and thaw cycles of 15 s each with a cryo unit spray. Two months of follow-up after last treatment was done to observe sustained re-growth of hair.

STATISTICAL ANALYSIS USED

The clinical response was evaluated by using regrowth scale at 4(th), 8(th), and 16(th) week.

RESULTS

11 patients were recruited, one patient dropped due to inability to attend follow-ups. Remaining ten patients completed the treatment and follow-up. Out of 10 patients, five patients (50%) showed an excellent response, three (30%) had a satisfactory response, one (10%) had a fair response, and one patient (10%) had a poor response. No serious adverse effects were seen. Sustained hair regrowth was seen in 80% of patients at the 16(th) week.

CONCLUSIONS

LN cryotherapy may be worth trying treatment in the management of recalcitrant AA.