الفهرس 
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Abstract
Alopecia areata (AA) is an important cause of non-scarring alopecia, that affects the scalp and/or body hair. Although, alopecia areata is a rather benign condition and causes no symptoms, it can cause significant psychosocial stress to patients. The course of the AA is extremely difficult to foresee, and hence no single treatment option seems to be effective in all subgroups of patients. Therefore, the urge for new therapeutic modalities is building up. Intralesional steroids, as triamcinolone acetonide, are used as first-line treatment for limited cases of alopecia. Yet,it is delivered by multiple painful intralesional injections. Platelet-rich plasma (PRP) is a new therapeutic tool in dermatology, and might be beneficial for hair regrowth. PRP is mainly delivered by intralesional injection. Topically applied drugs usually have less side effects. However, transepidermal drug delivery has its limitations. The stratum corneum presents a barrier to topical drug administration, with the challenge of effectively delivering therapies to the target hair follicles. Different techniques have been tested to enhance drug penetrations into the skin, these include ultrasound, microneedling, and recently transepidermal drug delivery (TED). Use of lasers for TED is known as “laser-assisted drug delivery’’. The use of microneedling devices has been utilized for the same purpose. These devices produce small channels through the stratum corneum, down to the dermis (microscopic treatment zones for ablative fractional laser, and physical puncturing for microneedling) to deliver drugs to the deeper skin layers .
The aim of this study was to evaluate the use of fractional carbon dioxide laser versus microneedling in the transepidermal delivery of triamcinolone acetonide and platelet rich plasma in treatment of alopecia areata.
This interventional comparative study was carried out on 60 patients, of either sex, aged 6-60 years, presenting with alopecia areata, diagnosed both clinically and dermoscopically. Patients were randomly allocated, by closed envelope method, into four equal groups, fifteen patients each. group I: Fractional Carbon dioxide laser (CO2 Laser) and triamcinolone acetonide (TrA; 10 mg/ mL). group II: Microneedling with Dermapen and triamcinolone acetonide (TrA; 10 mg/ ml). group III: Fractional Carbon dioxide laser (CO2 Laser) and Platelet-rich plasma (PRP). group IV: Microneedling with Dermapen and Platelet-rich plasma (PRP). Patients were assessed clinically and dermoscopically for signs of hhair regrowth. Severity of Alopecia Tool (SALT) score and hair regrowth scale was used to evaluate treatment response.