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Combination therapy using local corticosteroids and fractional erbium YAG laser was found to be an effective treatment method for alopecia areata.

Alopecia areata is an autoimmune condition characterized by non-scarring scalp and body hair loss. Compared to intralesional steroids, fractional laser treatment was found to be more favorable for promoting hair regrowth due to the adverse effects of the former. 

A study published in the European Chemical Bulletin compared the effectiveness of fractionated Erbium YAG laser alone to that of fractionated erbium YAG laser followed by local corticosteroid application for treating alopecia areata.

Study Population and Method

In this study, 30 patients were enrolled, and 63.3% were male. The mean age was 29 years. In each patient, the lesions were classified into A and B groups with similar Severity of Alopecia Tool (SALT) scores. Group A lesions were treated with fractionated erbium YAG laser alone, and group B lesions with fractionated Erbium YAG laser followed by a single local application of corticosteroid (clobetasol propionate).

Distinct Clinical Response With Laser-Corticosteroid Treatment

Fractionated erbium YAG laser followed by local corticosteroid application proved to be an efficient treatment method for alopecia areata. A statistically significant difference was observed between the two groups regarding clinical response (p=0.032). In group A, 3/30 (10%) patients showed a complete response to treatment, 22 (73.33%) had a partial response, and five had no response. In group B, 11/30 (36.7%) patients had a complete response, 17 (56.6%) had a moderate response, and two (6.7%) patients showed no response.

Substantial SALT Score Reduction in Group B
Both groups demonstrated a significant reduction in SALT score following therapy, with group B showing a greater reduction than group A (p < 0.001 vs. p = 0.032).

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Comparable Patient Satisfaction Across Treatment Groups
There was no significant difference in patient satisfaction between the two groups evaluated on a 10-point scale at the end of the study.

Equivalent Dermoscopic Assessment Outcomes
No significant superiority of one group over the other regarding dermoscopic assessment was observed between the two groups following treatment. After laser therapy in group A, there was a major reduction in yellow dots (from 76.7% to 33.3%), exclamation marks (from 63.3% to 16.7%), black dots (from 50% to 13.3%), empty follicles (from 30% to 6.7%), and a significant increase in short vellus hairs (from 20% to 50%, p=0.001). Following treatment in group B, there was a reduction in yellow dots (from 76.7% to 23.3%), exclamation marks (from 63.3% to 10%), black dots (from 50% to 10%), empty follicles (from 30% to 6.7%), and a significant increase in short vellus hairs (from 20% to 53.3%, p=0.01).   

 

Source:

Ibrahim, S., Shokeir, H., Yousry, A., Zawahry, Y., & Elsaie, M. (2023). Fractional Erbium YAG laser followed by topical clobetasol propionate versus Fractional Erbium YAG laser alone in the treatment of alopecia areata: a prospective randomized clinical trial. European Chemical Bulletin 2023, 12(10), 5361–5384. doi: 10.48047/ecb/2023.12.10.378