Combination of Photodynamic Therapy With 5-Aminolaevulinic Acid and Microneedling in the Treatment of Alopecia Areata Resistant to Conventional Therapies | PracticeUpdate



Combination of Photodynamic Therapy With 5-Aminolaevulinic Acid and Microneedling in the Treatment of Alopecia Areata Resistant to Conventional Therapies

Clinical and Experimental Dermatology

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• This study included 41 patients with moderate to severe recalcitrant alopecia areata, who were randomly divided into three treatment groups. No patients in group A (n=9; microneedling alone) had improvement in regrowth. Group B (n=15; photodynamic therapy [PDT] with 5-aminolaevulinic acid [ALA]) had 2 patients with complete regrowth and 5 with >50% improvement, although 4 patients had no response. Group C (n=17; microneedling along with PDT-ALA) demonstrated the best response, with 3 patients having complete regrowth, 7 patients with >50% improvement, and 1 patient with no response after six treatments performed every 3 weeks.

• The authors suggest that combination therapy with ALA-PDT and microneedling can be considered a novel option in the treatment of patients with recalcitrant alopecia areata. They hypothesize that this improved efficacy may be related to better penetration of ALA with microneedling and thus increased immunosuppressive activity of PDT.

– Caroline Crabtree, MD

Abstract

Alopecia areata (AA) is a complex immune-mediated disorder, which is difficult to treat. The available treatment options seem to have limited benefit, help only some patients and have a high relapse rate. We evaluated a new therapeutic option for moderate to severe AA based on the combination of photodynamic therapy (PDT) with 5-aminolaevulinic acid (ALA) and microneedling (MN). In total, 14 patients were enrolled, and these were randomly divided into 3 groups: Group A (MN alone; n = 9), Group B (ALA-PDT alone; n = 15) and Group C (combination of MN and ALA-PDT; n = 17). All patients were treated once every 3 weeks for a total of six treatments. The best clinical outcome was achieved in Group C, with complete hair regrowth observed in three patients, and an improvement of ≥ 50% and < 50% of the treated areas obtained in seven and six patients, respectively. Our report suggests that combination of ALA-PDT with MN could be an additional therapeutic option in moderate to severe AA, as MN allows better skin penetration of ALA and subsequent indirect immunosuppression.

Clinical and Experimental Dermatology

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

Clin Exp Dermatol 2019 Aug 30;[EPub Ahead of Print], CM Giorgio, G Babino, S Caccavale, T Russo, AB De Rosa, R Alfano, E Fulgione, G Argenziano 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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