A clinical and immunological study of phototoxic regimen of ultraviolet A for treatment of alopecia areata: a randomized controlled clinical trial

Abstract

Background: Various therapeutic agents have been described for alopecia areata but none is satisfactory. The use of ultraviolet A phototherapy in phototoxic regimens has emerged lately with promising results.

Objective: To determine the efficacy and safety of phototoxic regimen of psoralen ultraviolet A (PUVA) in comparison to conventional therapy with intralesional corticosteroids in patients with alopecia areata.

Methods: In this randomized controlled clinical trial, 40 patients were randomized to either phototoxic regimen of psoralen ultraviolet A group or potent intralesional corticosteroids group for three months. Study ended at six months. The primary outcome was treatment success: sustained regrowth of hair in ≥80% of the affected areas at six months. Tissue cytokines were assessed at zero and three months.

Results: At six months, treatment success was achieved by 45% of patients, similarly in both groups. Tissue cytokine expression correlated well with clinical response.

Conclusion: Phototoxic regimen of topical PUVA deserves a place among therapeutic tools used in management of alopecia areata especially in more extensive conditions where intralesional corticosteroids would not be suitable.

Trial registration: https://clinicaltrials.gov/ct2/show/record/NCT01559584

Keywords:

• Alopecia areata
• cytokines
• randomized controlled trial
• ultraviolet therapy
• phototoxic

Ethical approval

Ethical approval status: reviewed and approved by the Dermatology Research Ethics Committee, final approval no: 11/2017.

Disclosure statement

The authors report no conflict of interest.

Acknowledgements

We are indebted to Dr. Mohamed Eshra (M.D.), Physiology department, Faculty of Medicine, Cairo University, for undertaking the statistical analysis for this study.