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

Abstract

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.

Microneedling and Its Use in Hair Loss Disorders: A Systematic Review

“…of MN sessions Treatment duration Endpoints Effectiveness Adverse events Jadad score Aboeldahab et al. [ 28 ] n = 80 (50 m, 30 f); alopecia areata (AA) Comparison: cryotherapy versus MN Group 1: cryotherapy Group 2: MN MN automated pen, 1.00–2.00 mm needles, session endpoints marked as 4–5 passes longitudinally, vertically, and diagonally 6, once every 2 weeks 12 weeks Hair counts, hair density, Severity of Alopecia Tool (SALT) scores, photographic evaluation, self assessments Yes Hair counts, hair density, SALT scores, photographic evaluation, and self assessments improved in groups 1 and 2; higher changes to SALT scores in group 2 versus 1 No adverse events in group 2 3 Ragab et al. [ 29 ] n = 60 (48 m, 12 f); AA Combination: PRP solution Group 1: PRP injections Group 2: fractional CO 2 laser + PRP topical Group 3: MN + PRP topical MN roller, 1.50 mm needles, session endpoints marked as 4–5 passes longitudinally, vertically, and obliquely until mild erythema noted 3, once monthly 3 months SALT Yes SALT scores improved in groups 1, 2, and 3; no difference in SALT scores across groups No serious events reported; pain higher in group 1 versus group 3 3 Abdallah et al.…”

“…and Abdallah et al. showed that MN alone increased hair density and improved SALT scores, respectively [ 28 , 30 ]. However, Giorgio et al.…”

“…When comparing MN with cryotherapy, Aboeldahab et al. found significant increases to hair counts and hair densities across both interventions, with MN demonstrating greater changes to SALT scores versus cryotherapy [ 28 ]. Conversely, Abdallah et al.…”

“…and Abdallah et al. noted improvements to AA from MN alone, these results should be interpreted with caution due to relatively small sample sizes, as well as the 50% spontaneous recoveries observed in many AA studies with adequate controls [ 28 , 30 ]. Moreover, Giorgio et al.…”

Analysis of alopecia areata surveys suggests a threshold for improved patient-reported outcomes

“…AASIS has overall more evidence supporting internal consistency and validity, 18 and has recently also shown some trends of improvement in clinical trials of topical interventions, ciclosporin A and a Janus kinase inhibitor. [21][22][23] As we reported previously, 16 AA-QLI did not significantly improve in patients with AA responding to dupilumab treatment, while AASIS was significantly decreased in dupilumab responders, indicating less negative impact of AA on patients' QoL. We therefore aimed to explore further the utility of these questionnaires in patients with AA before and after treatment and to determine the therapeutic response threshold that will most likely improve the reported outcomes of patients with AA.…”