Transepidermal Delivery of Triamcinolone Acetonide or Platelet Rich Plasma using either Fractional Carbon Dioxide Laser or Microneedling in Treatment of Alopecia Areata

Abstract

Introduction: Transepidermal drug delivery,  using “laser-assisted drug delivery'', or microneedling, are new treatment modalities, that can improve drug penetration into skin in treatment of alopecia areata patients. Objective: To evaluate the use of fractional carbon dioxide laser versus microneedling in transepidermal delivery of triamcinolone acetonide and platelet rich plasma in alopecia areata treatment. Methods: Interventional comparative study carried out on 60 patients, randomly divided into four equal groups. Group I :Fractional Carbon dioxide laser and triamcinolone acetonide. Group II: Microneedling with Dermapen and triamcinolone acetonide. Group III: Fractional Carbon dioxide laser and Platelet-rich plasma. Group IV: Microneedling with Dermapen and Platelet-rich plasma. Patients were assessed clinically, using Severity of Alopecia Tool score and hair regrowth scale, and dermoscopically. Results: In all treatment groups, there was improvement in the Regrowth scale, with statistical significance between the different groups at fourth (p= 0.001*) and last (p= 0.008*) visits, with highest, most significant changes in Pen-Steroid group. Comparing Regrowth scale at last visit,  results were in favor of dermapen, compared to Carbon dioxide laser for Transepidermal drug delivery (p=0.023*); and in favor of triamcinolone acetonide, compared to Platelet-rich plasma as topical medication (p=0.015*). Dermoscopic signs of improvement included decrease in black dots, and appearance of Upright regrowing hairs (p= <0.001*). Conclusion: Microneedling and fractional Carbon dioxide laser can be effectively used for transepidermal drug delivery for Alopecia areata treatment. Microneedling for delivery of Triamcinolone acetonide showed best treatment outcomes. Dermoscopy can be used in alopecia areata for evaluation of treatment response.