Fractional CO ₂ laser versus microneedling as a transepidermal drug delivery system for the treatment of alopecia areata: A clinical dermoscopic evaluation

Abstract

New treatment modalities are rising for better clinical improvement in alopecia areata. This work aims to evaluate the efficacy of fractional CO2 laser and microneedling as a transepidermal drug delivery in cases with alopecia areata. The study included 30 patients with alopecia areata. All lesions in each patient have received randomly two different treatment modalities, fractional CO2 laser or microneedling followed by triamcinolone acetonide (TA) application according to group assignment. Sessions were done every month for a maximum of six sessions or complete resolution. Response to treatment was assessed on SALT score and dermoscopic imaging. Both treatment modalities showed a significant clinical improvement of alopecia areata, with a statistically significant reduction of SALT score for fractional CO2 laser group and microneedling group (p value <0.001). Moreover, there is a significant difference in the SALT score between both modalities (p = 0.013), whereas the reduction of the SALT score was more evident in microneedling group. On comparing the dermoscopy findings in fractional CO2 laser and microneedling treated areas before and after treatment, a significant reduction was found regarding all dermoscopic findings of alopecia areata. Fractional CO2 laser and microneedling as a transepidermal drug delivery could be a novel and effective treatment modality in alopecia areata. Dermoscopy is very useful to identify disease activity and early signs of clinical improvement during treatment.

Fractional carbon dioxide laser alone and as an assisted drug delivery for treatment of alopecia areata: a clinical, dermoscopic and immunohistochemical study

“…In agreement with previous studies [ 38 , 43 ], the percentage of improvement of AASI related negatively with high statistical significance to the patient's age and disease duration.…”

“…In agreement with us, Soror et al reported significant improvement in grading AA patches treated by FCL plus TA [ 42 ]. Also, Abd El Kawy et al observed ≥ 75% improvement (according to severity of alopecia tool) in 56.7% of AA patches treated by FCL + TA [ 43 ].…”

The role of laser and energy-assisted drug delivery in the treatment of alopecia

“…No significant difference in effectiveness Laser group: no significant adverse effects Pain score significantly less in laser group ( p = 0.002) RCT/1 Omar et al [ 13 ] AA TAC (10 mg/ml) AFL (CO 2 ; Punto, DEKA, Italy) Power: 10 W Dwell time: 500 ms, Stack: 2 Spacing: 700 m 30 participants randomized to monthly laser or microneedling, followed by TAC until resolution or for a maximum of 6 sessions Both groups had a significant reduction in SALT score ( p < 0.001) with reduction in SALT higher in microneedling group than laser group ( p = 0.013) No statistically significant difference in side effects between groups. Only mild pain and erythema were reported RCT/2 Abd ElKawy et al [ 14 ] AA Clobetasol propionate AFL (ER: YAG; XS dynamics Fotona S1-121d, Ljubljana Slovenia) Fluence: 3 J/cm 2 Frequency: 3–5 Hz Mode: short pulse Spot size: 7 mm 30 subjects with AA had lesions randomized to LEADD or topical clobetasol alone. The laser treatment occurred every 2 weeks for 2–3 weeks, followed by one application of topical clobetasol.…”

“…A RCT assigned patients to monthly microneedling or AFL (CO 2 ), both followed by application of triamcinolone acetonide (TAC) for six sessions or resolution of lesions. Both groups had a statistically significant reduction in severity of alopecia Tool (SALT) score ( p < 0.001) with a significant difference between groups favoring the microneedling group ( p = 0.013) [ 14 ]. Another comparative study for treatment resistant AA compared microneedling or AFL (CO 2 ), both followed by application of triamcinolone acetonide (TAC).…”

“…The results were mixed on whether LEADD is superior to monotherapy or microneedling. Two of the RCTs for AGA comparing LEADD to microneedling-assisted drug delivery found the microneedling to be the superior treatment modality [ 10 , 14 ]. Larger studies with different drugs are needed to directly compare treatment methods, various settings and depths of devices for treatment of the scalp.…”