Transepidermal Delivery of Triamcinolone Acetonide or Platelet Rich Plasma using either Fractional Carbon Dioxide Laser or Microneedling in Treatment of Alopecia Areata
Keywords:
Alopecia Areata, Drug Delivery Systems, Triamcinolone Acetonide, Platelet Rich Plasma, Carbon Dioxide LaserAbstract
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.
References
Issa MC, Pires M, Silveira P, Xavier de Brito E, Sasajima C. Transepidermal drug delivery: a new treatment option for areata alopecia? J Cosmet Laser Ther. Feb 2015;17(1):37-40. doi: 10.3109/14764172.2014.967778. PubMed PMID: 25260052.
Chatnallikar N, Asha G, Leelavthy B, Revathi T. Safety and efficacy of microneedling with autologous platelet-rich plasma in chronic and stable alopecia areata. J Pak Assoc Dermatol. 2018;28(1):59-63.
Trink A, Sorbellini E, Bezzola P, et al. A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata. Br J Dermatol. Sep 2013;169(3):690-694. doi: 10.1111/bjd.12397. PubMed PMID: 23607773.
Majid I, Jeelani S, Imran S. Fractional carbon dioxide laser in combination with topical corticosteroid application in resistant alopecia areata: A case series. J Cutan Aesthet Surg. 2018;11(4):217.
Chandrashekar B, Yepuri V, Mysore V. Alopecia areata-successful outcome with microneedling and triamcinolone acetonide. J Cutan Aesthet Surg. Jan 2014;7(1):63-64. doi: 10.4103/0974-2077.129989. PubMed PMID: 24761107.
Abdelghani R, Ahmed NA, Darwish HM. Combined treatment with fractional carbon dioxide laser, autologous platelet-rich plasma, and narrow band ultraviolet B for vitiligo in different body sites: A prospective, randomized comparative trial. J Cosmet Dermatol. Jun 2018;17(3):365-372. doi: 10.1111/jocd.12397. PubMed PMID: 28834191.
Amable PR, Carias RB, Teixeira MV, et al. Platelet-rich plasma preparation for regenerative medicine: optimization and quantification of cytokines and growth factors. Stem Cell Res Ther. Jun 7 2013;4(3):67.
Olsen EA, Hordinsky MK, Price VH, et al. Alopecia areata investigational assessment guidelines--Part II. National Alopecia Areata Foundation. J Am Acad Dermatol. Sep 2004;51(3):440-447. doi: 10.1016/j.jaad.2003.09.032. PubMed PMID: 15337988.
Mahmoudi H, Salehi M, Moghadas S, Ghandi N, Teimourpour A, Daneshpazhooh M. Dermoscopic Findings in 126 Patients with Alopecia Areata: A Cross-Sectional Study. Int J Trichology. May-Jun 2018;10(3):118-123.
Inui S, Nakajima T, Nakagawa K, Itami S. Clinical significance of dermoscopy in alopecia areata: analysis of 300 cases. Int J Dermatol. Jul 2008;47(7):688-693. doi: 10.1111/j.1365-4632.2008.03692.x. PubMed PMID: 18613874.
Miteva M, Tosti A. Hair and scalp dermatoscopy. J Am Acad Dermatol. Nov 2012;67(5):1040-1048. doi: 10.1016/j.jaad.2012.02.013. PubMed PMID: 22405573.
Tosti A, Iorizzo M, Botta GL, Milani M. Efficacy and safety of a new clobetasol propionate 0.05% foam in alopecia areata: a randomized, double-blind placebo-controlled trial. J Eur Acad Dermatol Venereol. Nov 2006;20(10):1243-1247. doi: 10.1111/j.1468-3083.2006.01781.x. PubMed PMID: 17062039.
Scott J, Huskisson EC. Graphic representation of pain. Pain. Jun 1976;2(2):175-184. PubMed PMID: 1026900.
Albalat W, Ebrahim HM. Evaluation of platelet-rich plasma vs intralesional steroid in treatment of alopecia areata. May 10 2019.
Prausnitz MR, Elias PM, Franz TJ, et al. Skin barrier and transdermal drug delivery. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia: Elsevier Saunders; 2012:2065-2073.
Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34(5):426-438.
Henry S, McAllister DV, Allen MG, Prausnitz MR. Microfabricated microneedles: A novel approach to transdermal drug delivery. J Pharm Sci. Sep 1999;88(9):948.
Hantash BM, Bedi VP, Chan KF, Zachary CB. Ex vivo histological characterization of a novel ablative fractional resurfacing device. Lasers Surg Med. Feb 2007;39(2):87-95.
Lynch MD, Bashir S. Applications of platelet-rich plasma in dermatology: A critical appraisal of the literature. J Dermatolog Treat. 2016;27(3):285-289. doi: 10.3109/09546634.2015.1094178. PubMed PMID: 26466811.
Maria-Angeliki G, Alexandros-Efstratios K, Dimitris R, Konstantinos K. Platelet-rich Plasma as a Potential Treatment for Noncicatricial Alopecias. Int J Trichology. Apr-Jun 2015;7(2):54-63.
Cohen PR. Laser-assisted drug delivery for the treatment of androgenetic alopecia: ablative laser fractional photothermolysis to enhance cutaneous topical delivery of platelet-rich plasma - with or without concurrent bimatoprost and/or minoxidil. Dermatol Online J. Feb 15 2019;25(2).
Sklar LR, Burnett CT, Waibel JS, Moy RL, Ozog DM. Laser assisted drug delivery: a review of an evolving technology. Lasers Surg Med. Apr 2014;46(4):249-262.
Wei-Ze L, Mei-Rong H, Jian-Ping Z, et al. Super-short solid silicon microneedles for transdermal drug delivery applications. Int J Pharm. 2010;389(1-2):122-129.
Petchsangsai M, Rojanarata T, Opanasopit P, Ngawhirunpat T. The combination of microneedles with electroporation and sonophoresis to enhance hydrophilic macromolecule skin penetration. Biol Pharm Bull. 2014;37(8):1373-1382. doi: 10.1248/bpb.b14-00321. PubMed PMID: 24931312.
Issa MCA, Casabona G, Santos Torreão P, Roale L. Transepidermal Drug Delivery. In: Issa MCA, Tamura B, eds. Daily Routine in Cosmetic Dermatology. Cham: Springer International Publishing; 2017:319-326.
Ganjoo S, Thappa DM. Dermoscopic evaluation of therapeutic response to an intralesional corticosteroid in the treatment of alopecia areata. Indian J Dermatol Venereol Leprol. May-Jun 2013;79(3):408-417. doi: 10.4103/0378-6323.110767. PubMed PMID: 23619446.
El Taieb MA, Ibrahim H, Nada EA, Seif Al-Din M. Platelets rich plasma versus minoxidil 5% in treatment of alopecia areata: A trichoscopic evaluation. Dermatol Ther. Jan 2017;30(1). doi: 10.1111/dth.12437. PubMed PMID: 27791311.
Hegde SP, Naveen KN, Athanikar SB, Reshme P. Clinical and dermatoscopic patterns of alopecia areata: a tertiary care centre experience. Int J Trichology. Jul 2013;5(3):132-136. doi: 10.4103/0974-7753.125608.
Rudnicka L, Rakowska A, Kerzeja M, Olszewska M. Hair shafts in trichoscopy: clues for diagnosis of hair and scalp diseases. Dermatol Clin. Oct 2013;31(4):695-708. doi: 10.1016/j.det.2013.06.007. PubMed PMID: 24075554.
Srivastava S, Goyal S, Dhillon K, Singh N. Dermoscopic evaluation of therapeutic response to intralesional triamcinolone acetonide in the treatment of Alopecia areata. Int J Adv Med. 2017;4(4):1175.
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