الفهرس 
List of abbreviationsOnly 14 pages are availabe for public view
 |  | from | 202 |  |  |
| | | from | 202 | | |
Abstract
Alopecia areata is a common autoimmune skin disease characterized by non-scarring patchy hair loss on the scalp and elsewhere on the body. AA may cause anxiety of patients and increases the risks of developing psychological and psychiatric complications (Pratt et al., 2017). It has unpredictable course with spontaneous remission, recurrence and exacerbation (Alkhalifah et al., 2010).
There is no universally proven therapy that induces and sustains remission, nor is there an accepted cure for AA (santos et al., 2015). No systemic agents are approved for use by the FDA for the treatment of AA, and the response of AA to treatment is unpredictable (Cranwell et al., 2019).
In the present study, the mean age of the patients (80 patients with mild or moderate AA), was (22.08 ± 1.5) years, with a range of 4–50 years and 46 (57.5%) of the patients were resident in urban areas. Smokers represented 15 (18.75%) of the patients.
In the current study, AA had a sudden onset in 42 (52.5%) of the patients, and a progressive course in 57 (71.3%) of the patients. The mean duration of AA was 11.07 ± 2.4 months. The exacerbating factors of AA were psychiatric disorders and infections and were reported by 48 (60%) of the patients. There was no statistically significant difference between the two studied groups as regards onset, course, duration, exacerbating factors, family history and past history of AA.
As regards the clinical evaluation of AA, the scalp was the most common site of AA in 66 (82.5%) of the patients, the total number of AA patches was 237, the mean size of patches was 17.17 ± 3.1cm2. AA was mild in 74 (92.5%) of the patients. The mean baseline SALT score was 7.39 ± 6.2.
As regards the comparison between the two treatment modalities, the onset of therapeutic response was after 3.13 ± 1.9 sessions in group 1 patients and after 3.60 ± 2.2 sessions in group 2 patients. The total number of responding patches was 59/130 (45.4%) in group 1 patients and 52/107 (48.6%) in group 2 patients.
Regarding the SALT score change, in both groups, the mean SALT score statistically significantly decreased from baseline to the end of the follow up period. The mean SALT score change percentage of 55.42 ± 46.3 was statistically significantly higher in group 2 than that of 54.49 ± 43.1 in group 1 patients.
In the present study, in both groups, the mean numbers of all of the trichoscopic signs of AA were statistically significantly decreased from the baseline to the end of follow up period, indicating a good response to both treatment modalities. However, there was no statistically significant difference between both treatment groups as regards, trichoscopic signs before and after treatment.
Concerning the hair density, in both treatment groups, the mean hair density statistically significantly increased from baseline to the end of the follow up period, however the mean hair density change percentage of (223.3 ± 184.6) was higher in group 2 patients, than a (199.6 ± 190.3) in group 1 patients, but this was statistically insignificant.
Regarding regrowth scale, excellent response of (>75%) terminal hair regrowth was achieved in 15 (37.5%) of group 1 patients compared to 14 (35%) of group 2 patients. However, a good therapeutic response
of (>50%) terminal hair regrowth, was achieved in a higher number of 23
(57.5%) in group 2 patients than that of 21 (52.5%) in group 1 patients.
As regards the patient’ self-assessment, the mean values of AASIS at baseline, after 6 sessions and at the end of the follow up period was statistically significantly lower in group 1 than in group 2 patients. Also, the mean AASIS change percentage of (62.44 ± 44.2) in group 1 patients, was higher than that of (59.66 ± 47.3) in group 2 patients, but this was statistically insignificant.
As regards, the safety and tolerability of both treatment modalities, none of group 2 patients experienced any considerable side effects, while those side effects (crusts formation, bullae and hypopigmentation) which were experienced by 6 (15%) of group 1 patients, were transient and didn’t necessitate termination of superficial cryotherapy.
Recurrence of AA was not encountered in any of the responders in both groups, indicating maintained hair regrowth, even after termination of the two treatment modalities.
Based on the multivariate analysis of the effect of prognostic factors on AA response to treatment, (positive family history of AA, moderate and progressive AA and the increase in size of AA patches), were the overall independent poor prognostic factors which decreased the response to treatment in the two treatment groups.
Conclusion:
It’s concluded that in this study, both the superficial cryotherapy using DMEP mixture and microneedling (as monotherapy each) were effective and safe treatment options for mild to moderate AA, however microneedling was more effective.
Our study is the first one to assesses the efficacy of DMEP based superficial cryotherapy and microneedling, both as a monotherapy in the treatment of AA. Our results are considered a basis for further studies to assesses the efficacy of DMEP in treating AA with more severe subtypes (recalcitrant AA, AT and AU), with trying different numbers and durations of the freeze thaw cycles to verify the optimum effective numbers and durations of the freeze thaw cycles.
Further studies with large sample size are recommended to compare the efficacy of DMEP with that of liquid nitrogen in the treatment of AA with various subtypes. Also, DMEP manufacturing companies should improve the quality and delivery system of DMEP based device to cover a larger surface area of AA patches for easy and effective application.
Our results also highlight the role of microneedling in the treatment of mild to moderate AA with a high safety profile, and encourage its use in treating AA either alone or in combination with various topical agents.
Extended use of both treatment modalities in children is recommended.