Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
Arch Dermatol Res. 2024 Jan 3;316(2):64. doi: 10.1007/s00403-023-02785-1.
A myriad of therapeutic modalities for alopecia areata are available; however, none is of high level of evidence, creating an immense need for the evaluation of other treatment modalities, of which topical sodium valproate is of potential role via proposed decrease in beta-catenin breakdown, despite its well-known side effect of hair fall as an oral therapy.
Evaluating the efficacy and the safety of sodium valproate (SV)-loaded nanospanlastics, in comparison to topical corticosteroids, this is the currently available gold standard topical treatment for patchy AA.
A total of 66 patients with patchy AA were randomly assigned to receive either topical mometasone furoate lotion or topical SV applied twice daily to all patches except a control patch, which was left untreated. Clinical, trichoscopic and biochemical assessments of beta-catenin tissue levels and Axin-2 gene expression were carried out at baseline and after 3 months.
Both therapeutic modalities were comparable. Potential efficacy was highlighted by significant improvement in the representative patch, the largest treated patch, to the control patch, the smallest untreated patch in both steroid and valproate groups (p = 0.027, 0.003 respectively). Both beta-catenin levels and Axin-2 gene expression were reduced after treatment, pointing to the inhibitory effect of dominating uncontrolled inflammatory milieu. Baseline beta-catenin was found to significantly negatively correlate with improvement in the representative patch in patients with baseline level above 0.42 ng/ml (p = - 0.042).
Both topical SV and steroids are of comparable modest efficacy. Thus, further evaluation of SV is due in combination with intralesional steroids and other anti-inflammatory treatment modalities, together with developing individualized approaches based on baseline beta-catenin level.
NCT05017454, https://clinicaltrials.gov/ct2/show/NCT05017454 .
斑秃有多种治疗方法；然而，没有一种方法具有高水平的证据，因此迫切需要评估其他治疗方法，其中局部用丙戊酸钠通过减少β-连环蛋白的分解具有潜在作用，尽管其作为口服治疗的已知副作用是脱发。
评估丙戊酸钠（SV）纳米粒载剂的疗效和安全性，并与局部皮质类固醇进行比较，这是目前治疗斑片状 AA 的标准局部治疗方法。
共有 66 名斑片状 AA 患者被随机分为接受局部糠酸莫米松乳膏或局部 SV 治疗，每天两次涂于所有斑块，除了一个对照斑块外，对照斑块未接受治疗。在基线和 3 个月后进行临床、毛发镜和组织β-连环蛋白水平和 Axin-2 基因表达的生物化学评估。
两种治疗方法具有可比性。在类固醇和丙戊酸钠组中，代表斑块（最大治疗斑块）与对照斑块（未治疗最小斑块）相比，都显示出显著改善（p=0.027，0.003），这表明潜在疗效。治疗后β-连环蛋白水平和 Axin-2 基因表达均降低，表明主导不受控制的炎症环境的抑制作用。在基线β-连环蛋白水平高于 0.42ng/ml 的患者中，基线β-连环蛋白与代表斑块的改善呈显著负相关（p=-0.042）。
局部 SV 和皮质类固醇的疗效相当温和。因此，需要进一步评估 SV 与皮质内类固醇和其他抗炎治疗方法的联合应用，以及基于基线β-连环蛋白水平制定个体化方法。
NCT05017454，https://clinicaltrials.gov/ct2/show/NCT05017454。
