الفهرس 
Overview of Alopecia AreataOnly 14 pages are availabe for public view
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Abstract
Alopecia areata (AA) is a form of a non-scarring autoimmune disease that affects hair follicles with no age, sex and race predilection. The intense emotional distress produced by AA causes disturbance in self-confidence and decrease self-esteem. In spite of significant variations in the clinical types of AA, it most commonly presents as well-defined round or oval lesions of partial scalp hair loss either as single or multiple patches (patchy AA) and can affect any hair bearing site. As yet, there is an argument about the disease course prediction and the response to treatment is variable. The exact cause of AA remains dilemma but immunological, genetic and environmental factors have been implicated.
Spontaneous hair regrowth might occur in up to 50% to 80% of patients within 1 year; however, it is also possible for additional patches to form that can coalesce into a large lesion or eventually involving the complete scalp (AT) or all scalp and body hairs (AU) in severe conditions.
Numerous therapeutics modalities are available for AA and can be used in combination. Intralesional corticosteroids are considered the golden standard for treating patchy AA of limited extent that involving < 50% of the scalp and for cosmetic sensitive area. Nevertheless, ILCS are used as adjunctive therapy in extensive AA. Minoxidil, non-specific hair promoting agent, is frequently used either as topical solution or intralesional injection combined therapy but its effectiveness is still a matter of debate.
The aim of this study was to evaluate the efficacy and safety of intradermal delivery of 5% minoxidil alone and in combination with first-line treatment intralesional triamcinolone acetonide for treatment of limited patchy alopecia areata. The current study included 20 adults with multiple patches of scalp alopecia areata, each patient had at least 5 scalp patches of minimally 3cm2 in size with limited severity where SALT score up to S2 (< 50% of scalp involvement), recruited from the Outpatient Clinic of Dermatology, Ain Shams University Hospital and EL-Houd EL-Marsoud Hospital.
The five scalp AA patches in each patient were treated as the following; Patch A (steroid group) was treated with intralesional triamcinolone acetonide 5mg/ml, Patch B (minoxidil group) was treated with intradermal injection of minoxidil 5%, Patch C (combined treatment group) was treated with equal volume combination of triamcinolone acetonide 5mg/ml and 5% minoxidil injection, Patch D (microneedling group) was subjected only to micro-needling procedure with dermal roller and lastly Patch E (control group) was left without treatment for observation. The tested treatment modalities and microneedling were delivered in 4 consecutive sessions 4 weeks apart and followed up by 1 month after completion of all sessions. Assessment was done clinically by SALT scoring; LAD score, lesion size, digital photography and trichoscopic documentation.
The vast majority of AA patients (95%) were males with predominance of young adult aged 16 to 45 years. The mean duration of the disease was 5 months and the mean age of first onset was 26 years. Two-thirds of the patients recalled previous incidents with patchy alopecia areata while the family history was present in one fifth of them. Forty percent of patients tried previously combination of topically applied agents and ILCS and fewer patients tried other treatment modalities. Scalp was affected in all patients and median SALT score at the time of presentation was 18.2%. Almost all of the patients (97%) had trichoscopic findings of yellow dots; three-quarter of them showed vellus hair, and two thirds showed black dots and more than half presented with both broken and tapering hairs.
All tested treatment modalities effectively improved AA patches conditions and reduced significantly the patch SALT score, LAD score and lesion size. The tested treatments resulted in hair regrowth with a median percent of 85%, 75%, 85%, 65% and 50% with intralesional steroid treatment, intradermal minoxidil injection, combined treatment, microneedling and control patch respectively. The intralesional steroid treatment and combined treatment showed marked significant changes in AA patches improvement when compared to the control patch while these changes were not significant in both minoxidil treatment and microneedling procedure when compared to control. On the other hand, addition of intradermal minoxidil to the intralesional steroid treatment provided no superior result over the injection of corticosteroids alone and was worthless as the outcome was nearly similar to that achieved by the sole injections of corticosteroids. This indicates the critical role played by corticosteroids in the combination and that minoxidil addition was insignificant and negligible.
Our study revealed that minoxidil was safe and well tolerated as burning sensation during the intradermal delivery of minoxidil was the most common side effect.
All in conclusion, the effect of intradermal minoxidil for improving AA was modest and comparable to both microneedling and spontaneous improvement in control and its addition to the steroid yielded no additive effect over the steroid effect. The main benefit of intralesional minoxidil treatment that it could enhance and speed the recovery in ordinary cases of AA and thus, it can be used only in patients who have contraindication to the golden standard intralesional corticosteroids treatment.