Transepidermal Delivery of Triamcinolone Acetonide or Platelet Rich Plasma using either Fractional Carbon Dioxide Laser or Microneedling in Treatment of Alopecia Areata

Abstract

Introduction: Transepidermal drug delivery, using “laser-assisted drug delivery'', or microneedling, are new treatment modalities, that can improve drug penetration into skin in treatment of alopecia areata patients. Objective: To evaluate the use of fractional carbon dioxide laser versus microneedling in transepidermal delivery of triamcinolone acetonide and platelet rich plasma in alopecia areata treatment. Methods: Interventional comparative study carried out on 60 patients, randomly divided into four equal groups. Group I :Fractional Carbon dioxide laser and triamcinolone acetonide. Group II: Microneedling with Dermapen and triamcinolone acetonide. Group III: Fractional Carbon dioxide laser and Platelet-rich plasma. Group IV: Microneedling with Dermapen and Platelet-rich plasma. Patients were assessed clinically, using Severity of Alopecia Tool score and hair regrowth scale, and dermoscopically. Results: In all treatment groups, there was improvement in the Regrowth scale, with statistical significance between the different groups at fourth (p= 0.001*) and last (p= 0.008*) visits, with highest, most significant changes in Pen-Steroid group. Comparing Regrowth scale at last visit, results were in favor of dermapen, compared to Carbon dioxide laser for Transepidermal drug delivery (p=0.023*); and in favor of triamcinolone acetonide, compared to Platelet-rich plasma as topical medication (p=0.015*). Dermoscopic signs of improvement included decrease in black dots, and appearance of Upright regrowing hairs (p= <0.001*). Conclusion: Microneedling and fractional Carbon dioxide laser can be effectively used for transepidermal drug delivery for Alopecia areata treatment. Microneedling for delivery of Triamcinolone acetonide showed best treatment outcomes. Dermoscopy can be used in alopecia areata for evaluation of treatment response.

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

“…Treatment every 2 weeks for 10 total treatments with 12-week follow-up One-half: high pulse energy followed by topical PRP Other half: low pulse energy followed by topical PRP Mean total hair density: increased significantly in high pulse group compared to low pulse group ( p = 0.023) Tolerable pain (7), mild pruritis (2), dandruff (4) Pilot study/0 Hanthavichai et al [ 9 ] AA PRP, TAC (10 mg/mL) AFL (10,600 nm CO 2 ; Advanced Technology Laser Company, Ltd., Shanghai, China) Power: 20 W Density: 4 pulses per inch Pulse duration/time: 3 ms 60 participants randomized with treatment every 3 weeks for four treatments with 4-week follow-up Group 1: laser and TAC Group 2: microneedling and TAC Group 3: laser and PRP Group 4: microneedling with PRP Groups 1 and 3: laser treatment was followed by application of topical drug Groups 2 and 4: drug was applied before, during, and after microneedling Regrowth scales showed microneedling to be more effective than laser for drug delivery ( p = 0.023) with TAC working better than PRP ( p = 0.015). All treatment groups showed improvement Laser: discomfort from heat in some patients Both groups: pain more tolerable than intralesional injections RCT/3 El Mulla et al [ 10 ] AA TAC (20 mg/ml) AFL (CO 2 ), RFMN (both devices not specified) RFMN: Roller: 10-mm-width wheel with 6 coags/disc with 50 pins/coag Depth: 100–150 μm Diameter 80–120 μm Laser: Depth: 150–300 μm Diameter 125–150 μm Case series of 5 patients treated with laser or RFMN then topical TAC then acoustic pressure wave ultrasound (US) All participants had complete resolution of their lesions. Two patients with RFMN after three and six sessions, respectively.…”

“…Each group had treatments every 3 weeks for four treatments. All treatment groups showed improvement; however, regrowth scales showed microneedling to be more effective than laser for drug delivery ( p = 0.023) with TAC working better than PRP ( p = 0.015) [ 10 ]. LEADD with TAC is an effective treatment for AA, but it may not be superior to microneedling-assisted drug delivery.…”

“…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.…”

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

“…Previous studies have demonstrated superior result with combined fractional CO 2 laser and topical drugs in the treatment of different skin diseases such as vitiligo, wart, melasma, and alopecia. [7][8][9][10] In this clinical trial we evaluate the efficacy of the combination of FCO 2 laser and bimatoprost compared to bimatoprost alone in the treatment of alopecia areata.…”

“…Transepidermal drug delivery (TDD), in which various ablative techniques create microthermal channels, is a novel noninvasive therapeutic technique to boost the efficacy of topical drugs due to the enhancement of the penetration of topical drug into the dermis and target organ. Previous studies have demonstrated superior result with combined fractional CO 2 laser and topical drugs in the treatment of different skin diseases such as vitiligo, wart, melasma, and alopecia 7–10 . In this clinical trial we evaluate the efficacy of the combination of FCO 2 laser and bimatoprost compared to bimatoprost alone in the treatment of alopecia areata.…”