Metwally Dina, Abdel-Fattah Rania, Hilal Rana Fathy
Department of Dermatology, Kasr Al Ainy Teaching Hospital, Cairo University, Al-Saray Street, El Manial, Cairo, Cairo, 11956, Egypt.
Resident of Dermatology, Ministry of Health, Cairo University, Cairo, Egypt.
Arch Dermatol Res. 2022 Mar;314(2):167-182. doi: 10.1007/s00403-021-02201-6. Epub 2021 Mar 19.
Alopecia Areata (AA) is a common autoimmune disease, with an unpredictable course and no standard treatment with guaranteed outcome. Intralesional corticosteroids is the most commonly used treatment for patchy AA, but with a common side effect of localized atrophy. Thirty patients with localized AA, with three patches were included in this study. Each alopecic patch in each patient was subjected to treatment by intralesional carbon dioxide injection (carboxy therapy), intralesional corticosteroids (ILC) and a combination of both. Sessions were done every 2 weeks for a total of 12 weeks, followed by a 2-month follow-up period. Evaluation was done at baseline, after treatment and after follow-up, clinically by modified SALT score (a novel modification of the SALT score), dermoscopically (yellow dots, black dots, tapered hair, regrowing hair) and by photography. All treatment regimens resulted in significant improvement of mSALT score and dermoscopic parameters. Comparison of the three treatment modalities revealed a 79.2% hair regrowth following the combined regimen, 69.5% improvement after ILC, and 50% improvement after carboxy therapy, with a statistical difference. The combined regimen also produced the largest significant increase in regrowing hair after treatment. Side effects included temporary pain during injection and relapse in the alopecic patch treated by ILC in one patient. All treatment regimens proved effective for treatment of patchy alopecia areata, with highest efficacy encountered following the combined modality as it caused the greatest and earliest hair regrowth.Study registered in Protocol Registration and Results System (clincaltrials.gov). Registration number: NCT04228029.
斑秃（AA）是一种常见的自身免疫性疾病，病程不可预测，且没有能保证疗效的标准治疗方法。皮损内注射皮质类固醇是治疗局限性斑秃最常用的方法，但存在局部萎缩这一常见副作用。本研究纳入了30例局限性斑秃患者，每人有3处斑秃皮损。对每位患者的每处斑秃皮损分别采用皮损内注射二氧化碳（羧基疗法）、皮损内注射皮质类固醇（ILC）以及两者联合的方法进行治疗。每2周进行一次治疗，共治疗12周，随后进行2个月的随访期。在基线、治疗后和随访后进行评估，临床评估采用改良SALT评分（SALT评分的一种新改良），通过皮肤镜检查（黄点、黑点、锥形毛发、再生毛发）和拍照进行。所有治疗方案均使mSALT评分和皮肤镜参数有显著改善。三种治疗方式的比较显示，联合治疗方案后毛发再生率为79.2%，ILC治疗后改善率为69.5%，羧基疗法治疗后改善率为50%，存在统计学差异。联合治疗方案在治疗后再生毛发的显著增加幅度也最大。副作用包括注射时的短暂疼痛以及1例接受ILC治疗的斑秃皮损出现复发。所有治疗方案均被证明对局限性斑秃有效，联合治疗方式疗效最高，因为它能引起最大程度且最早的毛发再生。该研究已在临床试验注册与结果系统（clincaltrials.gov）注册。注册号：NCT04228029。
