Failure to treat alopecia areata with photodynamic therapy

Abstract

We treated six patients with static alopecia areata (AA) with photodynamic therapy (PDT). All patients had received other treatment before starting PDT, but with no benefit. All previous treatments were stopped at least 3 months before beginning PDT, and no other treatment was given during the study period. PDT was used on only one of the affected areas, or if there was only one affected area, to only part of that area; untreated areas served as controls. For all patients methylaminolaevulinic acid was applied under occulsion 3 h after irradiation with red light at 630 nm (37 J/cm(2), 7.5 min). One session was carried out each month. Clinical and fluorescence photographs were taken with a digital camera connected to ultraviolet flashes, both before and after each treatment. None of the patients with AA of the scalp achieved complete hair regrowth, either in the treated or the untreated areas. Two of the patients showed growth of some thin hair over < 10 of the treated area. The remaining patients had no change. However, the patient with AA of the beard experienced complete regrowth after four sessions. To our knowledge, this is the first case of AA treated with PDT in this location. It may be that AA of beard hair responds better to PDT, but further studies are necessary.

Combination of photodynamic therapy with 5‐aminolaevulinic acid and microneedling in the treatment of alopecia areata resistant to conventional therapies: our experience with 41 patients

“…One study 6 reported hair regrowth with a topical formulation of haematoporphyrin and ultraviolet A irradiation, but another study 7 used topical PDT with 5-20% ALA twice weekly for a total of 20 treatments in patients with extensive AA (75% of scalp involved) without any evidence of hair regrowth. These results were confirmed by Fern andez-Guarino et al, 8 who reported a case series of six patients with failure of MAL-PDT for AA.…”

Photodynamic Therapy with Methyl 5-Aminolevulinate Acid Might Be Ineffective in Recalcitrant Alopecia Totalis Regardless of Using a Microneedle Roller to Increase Skin Penetration

“…They suggested that aminolevulinic acid (ALA)‐PDT induces apoptosis in cell culture and tumors. ALA‐PDT can theoretically improve AA by inducing apoptosis in the T lymphocytes around the hair follicles, but other authors used ALA and MAL‐PDT for severe AA and, unfortunately, they found that these were not effective 8 . They suggested that the absence of microscopic fluorescence in the inflammatory infiltrate around the hair follicle after photosensitizer application might explain the absence of significant hair regrowth in the study that they conducted.…”

An update on alopecia areata

“…Most recently, Fernández-Guarino et al [40] reported poor responses to PUVA in all areas except the beard. Furthermore, potential long-term side effects of PUVA, including eye damage, photo-aging, and increased risk for skin cancers and melanoma, limit its use.…”