Prasanna Harish, Srinivas Rajashekar Talari, Kuppuswamy Suresh Kumar, Keloji Hanumanthayya, Ravikumar Pavithra Thotta
Department of Dermatology Venereology and Leprosy, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India.
J Cutan Aesthet Surg. 2024 Jan-Mar;17(1):34-40. doi: 10.4103/JCAS.JCAS_31_23.
Alopecia areata (AA) is a non-scarring alopecia of chronic autoimmune etiology with heterogenous severity against the anagen hair follicle over the scalp, beard, or any part of the body and is associated with a significant psychological morbidity in the mental status of the patients leading the patients to seek treatment for cosmetic reasons. The management of AA is very unpredictable and is associated with various cosmetic adverse effects. This study aimed at comparing the efficacy and safety of a novel procedure of laser-assisted drug delivery system of steroids with the first-line procedure of intralesional steroids (ILS) for the treatment of patchy AA.
To assess and compare the efficacy and safety of fractional CO laser in combination with topical triamcinolone acetonide aqueous solution and intralesional triamcinolone acetonide as a monotherapy and in the treatment of AA.
A total of 60 patchy AA patients were included in this study. Patients were randomized into two equal groups: Group A and Group B with 30 patients in each group using a computer-generated block randomization. Patients in Group A received fractional CO laser with topical triamcinolone acetonide aqueous solution and Group B received ILS. Both groups received treatment for five settings with each setting a gap of 3 weeks. The efficacy and safety of treatment modalities in both groups were assessed using global photograph assessment (GPA)-scale, lesional area density score percentage of improvement (LAD score improvement %), visual discomfort scale (VDS), visual analogue scale, and documentation of adverse effects in each setting.
Efficacy of treatment modality-assessed using means score of GPA-scale and LAD score improvement % suggests quicker results to patients in Group B in initial settings but drastic improvement happens to patients in Group A in subsequent settings. At the end of 5th setting, GPA-scale and LAD score improvement % suggest maximum efficacy in patients in Group A and they are statistically significant (-value < 0.001). The mean VDS in both groups suggests maximum discomfort in Group A, yet the patient satisfaction at the end of 5th setting was maximum with patients in Group A and they are statistically significant (-value < 0.001). Cosmetic notable adverse effect of atrophy of skin was documented in 30% of patients in Group B.
This study showed that fractional CO laser with topical triamcinolone acetonide is a better treatment modality than the intralesional triamcinolone acetonide for the treatment of AA with respect to efficacy, safety, and adverse events.
斑秃（AA）是一种慢性自身免疫性病因导致的非瘢痕性脱发，对头皮、胡须或身体任何部位的生长期毛囊的严重程度各异，且与患者心理状态的显著心理疾病相关，导致患者因美容原因寻求治疗。AA的治疗非常不可预测，且伴有各种美容不良反应。本研究旨在比较一种新型的类固醇激光辅助给药系统与一线的病灶内注射类固醇（ILS）治疗斑秃的疗效和安全性。
评估和比较分数CO2激光联合外用曲安奈德水溶液和病灶内注射曲安奈德作为单一疗法治疗斑秃的疗效和安全性。
本研究共纳入60例斑秃患者。使用计算机生成的区组随机化方法将患者随机分为两组：A组和B组，每组30例患者。A组患者接受分数CO2激光联合外用曲安奈德水溶液治疗，B组患者接受病灶内注射曲安奈德治疗。两组均接受5次治疗，每次治疗间隔3周。使用整体照片评估（GPA）量表、病灶面积密度评分改善百分比（LAD评分改善%）、视觉不适量表（VDS）、视觉模拟量表以及记录每次治疗中的不良反应来评估两组治疗方式的疗效和安全性。
使用GPA量表的平均评分和LAD评分改善%评估治疗方式的疗效表明，在初始治疗阶段B组患者的效果更快，但在后续阶段A组患者有显著改善。在第5次治疗结束时，GPA量表和LAD评分改善%表明A组患者的疗效最佳，且具有统计学意义（P值<0.001）。两组的平均VDS表明A组的不适程度最高，但在第5次治疗结束时A组患者的满意度最高，且具有统计学意义（P值<0.001）。B组30%的患者记录到了皮肤萎缩这一明显的美容不良反应。
本研究表明，就疗效、安全性和不良事件而言，分数CO₂激光联合外用曲安奈德是一种比病灶内注射曲安奈德更好的治疗斑秃的方式。
