Fractional carbon dioxide laser-assisted topical steroid delivery versus intralesional steroid in the treatment of alopecia areata

Background Alopecia areata is a common disease that affects the psychological well-being of the affected individuals. No single treatment option is proved to be effective and safe in its management. Laser-assisted drug delivery is a new method for the management of different dermatological diseases. Objective To evaluate the effectiveness of fractional carbon dioxide laser-assisted topical steroid delivery in the management of alopecia areata. Patients and methods A total of 30 patients with alopecia areata with two or more nonadjacent patches were included. Patients were randomized and given two separate treatment modalities in two different patches in the same individual. One patch was treated with fractional carbon dioxide laser followed by topical triamcinolone acetonide (group I), and the other was treated with intralesional triamcinolone acetonide (group II). Follow-ups by MacDonald Hull and Norris grading were done every 3 weeks for 3 months. Results The mean grading score in group I patches treated with ablative fractional CO2 laser followed by the topical steroid application at fourth follow-up was 3.37±0.76, and the mean grading score in group II patches treated with intralesional steroid at fourth follow-up was 3.73±0.58. There was significant improvement in the MacDonald Hull and Norris grading score every follow-up in both groups. However, group II patches showed significantly higher mean grading score as compared with group I patches. The mean pain score in group II patches was significantly higher than that in group I patches. Conclusion The use of fractional carbon dioxide laser to assist topical steroid delivery is a promising, safe, and effective method for the treatment of alopecia areata. Although intralesional steroid treatment showed more significant results, we thought that the low pain score in patients treated with laser-assisted drug delivery is more advantage, which increases their compliance to treatment