A Comparative Randomised Clinical Trial To Determine The Efficacy Of 308nm Excimer Lamp Vs Topical Fluticasone Cream In The Treatment Of Alopecia Areata

Abstract

Background: Alopecia areata (AA) is a common form of non-scarring hair loss of scalp and/or body. Genetic predisposition, autoimmunity, and environmental factors play a major role in the etiopathogenesis of AA. Patchy AA is the most common form. Alopecia areata (AA) is considered as a T-cell infiltrated autoimmune disorder. The 308-nm excimer laser is thought to be capable of inducing T-cell apoptosis in vitro, suggesting that the 308-nm excimer lamp (not laser) might be effective for the treatment of AA. Several topical corticosteroids with varying levels of efficacy have been used to treat alopecia areata. Objectives: Objective of this study is to compare the efficacy of 308-nm excimer lamp vs. topical micronized fluticasone propionate 0.05% cream in the treatment of alopecia areata. Materials and method: Twenty five patients with two or more comparable patches of alopecia areata (AA) were recruited into the study. One patch was treated with 308nm excimer lamp twice weekly (test patch) and other patch with topical micronized fluticasone propionate 0.05% cream twice daily (control patch). The total duration of treatment was for three months and a monthly follow up for three months. Baseline clinical images and dermoscopic images were taken. After the end of therapy, clinical and dermoscopic images were taken during the follow up period of monthy three months to assess hair regrowth. The 2 primary efficacy parameters assessed were: Increase from baseline hair count at 12 weeks and hair regrowth score on six point scale at 12 weeks and during the follow up. Two blinded investigators evaluated response on computer screen using dermoscopic images. Results: (1) Hair counts – The mean increase in hair count at week 12 was significantly greater for the study group compared to the control group. (2) Hair X regrowth score – In the study group, hair regrowth was started at 4th session onwards with score of 3-4 and whereas in control group hair regrowth was started at 14th session onwards with score of 1-3. Conclusion: The results of this study did not establish “topical fluticasone cream” as a unique therapeutic modality for AA. The results with “excimer therapy” indicated that this therapy induces effective hair regrowth within short duration without any serious side effect for treating AA. However, the total number and frequency of sessions and long-term sustainability of response of excimer therapy need to be evaluated within a larger population.