Combined microneedling with topical vitamin D3 or bimatoprost versus microneedling alone in the treatment of alopecia areata: A comparative randomized trial

Abstract

Introduction: Alopecia areata (AA) is a challenging disease with variable treatment outcomes. Hair follicles express vitamin D receptors. Therefore, vitamin D3 may be promising for AA treatment through immunomodulatory mechanisms. The efficacy of bimatoprost in scalp AA treatment was reported by few studies. Objective: To evaluate the efficacy and safety of microneedling (MN) with topical vitamin D3 versus MN with bimatoprost in comparison with MN alone in the treatment of localized AA. Patients and Methods: Seventy-five patients with localized AA were divided into three groups. The first group: 25 patients were treated with MN alone. The second group: 25 patients treated with MN combined with topical vitamin D3. The third group: 25 patients treated with MN combined with bimatoprost solution. The response was evaluated clinically and dermoscopically.Results: At the end of the study, all groups showed a statistically significant decrease in the SALT score compared to the baseline. The clinical response (regrowth scale): vitamin D and bimatoprost groups showed a statistically significant higher regrowth scale compared to MN alone group (p-value = 0.000). After treatment, hair regrowth was significantly higher in MN combined with bimatoprost than in MN combined with topical vitamin D3. However, after 3 months of follow-up, there was no statistically significant difference between both groups. Side effects were mild and transient in all groups. Conclusion:Topical vitamin D3 and bimatoprost combined with MN are safe and effective therapeutic options for localized AA.

The role of fractional laser‐assisted drug delivery in enhancing the efficacy of topical bimatoprost solution in the treatment of alopecia areata: An intra‐patient comparative randomized clinical trial

“…In the current study, significantly higher percentage of reduction in SALT score was demonstrated in combined FCO 2 and bimatoprost (46.43 ± 4.35%) that was nearly similar to the result of combined microneedling and bimatoprost in aforementioned study. Whereas monotherapy with bimatoprost revealed lower reduction in SALT score (21.16 ± 4.06%) that was approximately equal to the monotherapy with microneedling in Ali study 19 . In this study, although fractional ablative laser led to significantly increased efficacy of topical bimatoprost solution; however percentage of excellent improvement was still relatively low in combination group (15%).…”

“…At the end of treatment, excellent hair regrowth (more than 75%) was achieved significantly higher in bimatoprost group compared with vitamin D group or monotherapy group (36%, 20%, and 4%, respectively). 19 In the current study, significantly higher percentage of reduction in SALT score was demonstrated in combined FCO 2 and bimatoprost Limitations of this clinical trial were small number of participants and short duration of follow-up. Moreover, in order to eliminate possibility of spontaneous improvement, it was better to compare the results with untreated cases as control group.…”

“…Significantly higher reduction in SALT score was achieved with combined microneedling and bimatoprost (51.2%) compared to combined microneedling and topical vitamin D (37.5%) or microneedling alone (20%). At the end of treatment, excellent hair regrowth (more than 75%) was achieved significantly higher in bimatoprost group compared with vitamin D group or monotherapy group (36%, 20%, and 4%, respectively) 19 …”