Successful response to photodynamic therapy with 5‐aminolevulinic acid nanoemulsified gel in a patient with universal alopecia areata refractory to conventional treatment

Abstract

Alopecia areata (AA) is a common autoimmune disease that affects hair follicles and results in nonscarring hair loss. Pathophysiology remains actually unclear. However, genetics and immunity are confirmed as the most important contributors to disease. From the clinical point of view, AA is most often limited to a certain area in the form of alopecic plaques, but it can develop as a total loss of hair on the scalp (AA totalis) or it can even affect the entire body surface (AA universalis), causing a great psychosocial impact on the patient's life. 1 These extensive forms, with a worse prognosis, become frequently a real challenge for the dermatologist, as there are currently no fully effective therapeutic alternatives. 2,3 A 52-year-old woman with a personal history of hypothyroidism and Loeys-Dietz syndrome was attended at our Dermatology Department complaining a 2-year history of diffuse AA with ophiasis pattern. Complimentary test performed including blood cell count, general biochemistry, erythrocite sedimentation rate, C reactive protein, thyroid profile, and autoantibodies showed no anomalies. A psychological evaluation of the patient who ruled out anxiety-depressive syndrome was carried out. The dermatology life quality index (DLQI) scored 6. Treatment with minipulses of dexamethasone 6 mg twice weekly, methotrexate weekly, and topical minoxidil daily was then started. After 6 months of treatment, dexamethasone was suspended because of the appearance of cushingoid signs on examination, and methotrexate because of gastrointestinal intolerance. Other treatments with no satisfactory response included intralesional corticosteroids (triamcinolone of 40 mg/mL per 1 mL injection every month), topical immunomodulation

Photodynamic Therapy Review: Principles, Photosensitizers, Applications, and Future Directions

“…PDT is a minimally invasive procedure that is clinically used in the treatment of several oncologic human diseases, such as skin, esophageal, head and neck, lung, and bladder cancers [ 57 ]. However, PDT also has several non-oncologic applications [ 58 ], including the treatment of non-cancerous human diseases, such as dermatologic (acne [ 59 ], warts [ 60 ], photoaging [ 61 ], psoriasis [ 62 ], vascular malformations [ 63 ], hirsutism [ 64 ], keloid [ 50 ], and alopecia areata [ 65 ]), ophthalmologic (central serous chorioretinopathy [ 66 ] and corneal neovascularization [ 67 ]), cardiovascular (atherosclerosis [ 68 ] and esophageal varix [ 69 ]), dental (oral lichen planus [ 70 ]), neurologic (Alzheimer’s disease [ 71 ]), skeletal (rheumatoid arthritis [ 72 ]), and gastrointestinal (Crohn’s disease [ 73 ]).…”

Alopecia areata. Diagnostic and therapeutic recommendations of the Polish Society of Dermatology. Part 2: Treatment

“…The risk of serious adverse events in these studies was comparable to placebo. phototherApy There are reports on the efficacy of UVB 311 nm [95], PUVA and PUVA-turban [96,97], excimer laser (380 nm) [98] as well as photodynamic therapy [99]. UV-based methods (UVB 311, PUVA, UVA1, 308-nm excimer laser) may be considered in selected cases.…”

“…Istnieją pojedyncze doniesienia o skuteczności naświetlań UVB 311 nm [95], PUVA i PUVA-turban [96,97], UVA 1 , lasera ekscymerowego emitującego promienie UV 380 nm [98], a także terapii fotodynamicznej [99].…”

Effectiveness and safety of baricitinib in patients with moderate‐to‐severe refractory alopecia areata in real world: An open‐label, single‐center study

“…Although spontaneous regrowth is possible in some patients, many patients, especially patients with severe AA, have no response to the treatments including minoxidil and glucocorticoids. In other words, alopecia can be very refractory in these patients 4–7 . In recent years, with the development in the pathogenesis research of AA, JAK inhibitors have demonstrated promising effectiveness in treating moderate‐to‐severe AA 8 .…”

“…words, alopecia can be very refractory in these patients. [4][5][6][7] In recent years, with the development in the pathogenesis research of AA, JAK inhibitors have demonstrated promising effectiveness in treating moderate-to-severe AA. 8 However, few previous studies have focused on the effectiveness of baricitinib in patients who react poorly to other AA therapies.…”