الفهرس 
A comparative study of TCA 35% and phenol 88% peels as monotherapy versus combination therapy with N-acetyl-L-cysteine in patchy alopecia areata
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Abstract
Background: Alopecia areata (AA) is a tissue-specific autoimmune disorder wherein anagen hair follicles sustain a T-cell-mediated inflammatory assault. It commonly presents with circumscribed patches of non-scarring hair loss. It implies a significant psychosocial burden. A myriad of therapeutic modalities are available for the treatment of AA, but none has yet proven uniformly effective. Chemical peeling can potentially be used in the treatment of AA; primarily acting via therapeutic wounding with subsequent release of growth factors and cytokines. Aim of work: To evaluate the efficacy, safety, and tolerability of TCA 35% peel in comparison to phenol peel 88% in AA treatment, to determine whether oral N-acetyl-L-cysteine (NALC) has an additive value to chemical peels in subjects with AA, and to assess the impact of these interventions on patients{u2019} quality of life. Methodology: A total of 20 patients with multifocal patchy AA of the scalp ({u2265}2 patches) were enrolled,wherein a total of 40 patches were subjected to chemical peeling byTCA 35% and phenol 88%; each applied to a distinct patch in the same individual, respectively, in tandem, on 3-weekly basis for 3 consecutive months. Within the studied group, subjects were further randomized to two equal Groups; either group A (Chemoexfoliation monotherapy) or group B (Chemoexfoliation combined with oral NALC).Comparative assessment was carried out utilizing trichoscopic scaled scores of dystrophic and terminal hairs, respectively, SALT score, DLQI score as well as the global patients{u2019} satisfaction scaled score. Adverse effects were monitored clinically, trichoscopically, and via direct questioning