Excimer Laser in Alopecia Areata: Patchy Alopecia Responds Best

Efficacy of 308 nm Excimer Laser in Alopecia Areata:

Excimer laser remains a treatment option for alopecia areata. Not too long ago, we reviewed a meta-analysis from South Korea which included 9 prospective clinical studies involving 129 patients with alopecia areata. This meta-analysis concluded that excimer lasers helped around 50 % of patients.

A recent study from France retrospectively evaluated the efficacy of excimer laser in patients with alopecia areata. The end point they chose for the study was SALT 75 which meant a 75 % decrease in the SALT score (alopecia areata severity score).

A total of 36 patients were included in the study. The median age at the beginning of AA was 25 (range 3 to 61). Median number of years alopecia areata had occurred before starting the excimer laser was 1 year (range 0 to 41).

A total of 29 presented hair loss scalp area less than 50% with 25 having patchy AA and 4 patients having ophiasis alopecia areata. 7 patients had hair loss scalp area >50%. 5 presented hair loss areas between 50% to 90% and 2 patients had alopecia totalis.

All the patients were treated twice weekly. Initial fluencies were 50 mJ/cm2 below their minimal erythema dose. Fluencies were then increased by 50 mJ/cm2 every two sessions. Median and mean EL sessions were 24 (range 5 to 67).

What were the Results?

52% of patients achieved a SALT 75 (19 patients). Patients with patchy alopecia areata responded best with 56 % (14 of 25) achieving the SALT75 target. Patients with patchy alopecia areata who used excimer laser alone had the same amount of regrowth as those with patchy alopecia areata who used the excimer laser with other treatments. 3 of 4 with ophiasis form of alopecia areata didn’t have any benefit at all from excimer laser. The overall response rate for severe alopecia areata forms was 57 % but many who had successful regrowth used excimer laser with systemic therapies.

There were 11 pediatric patients in the study. 7 of the 8 pediatric patients with patchy alopecia areata had a good response to excimer laser. None of the pediatric patients with alophiasis, totalis or advanced AA had any response.

6 patients (16.7%) had relapses after the treatment was stopped and all of these relapses occurred within the first year. 2 patients with relapse resumed excimer laser treatment again - one had full regrowth and one had no regrowth.

Side effects were mild and included mild redness and hyperpigmentation.

Conclusion

The authors concluded that excimer laser is a safe option for alopecia areata and effective for about 50 % of patients with patchy alopecia. Children with patchy alopecia areata also responded quite well in this study. Ophiasis alopecia areata does not seem to respond well to laser nor does long standing alopecia areata (more than 10 years). 1 out of every 6 patients will relapse following cessation of therapy and this typically occurs within the first several months after stopping excimer laser.

REFERENCE

Di Fillipo et al. Efficacy of 308-nm excimer therapy in alopecia areata: a retrospective study with long-term follow-up Photodermatol Photoimmunol Photomed 2022 Jan 21.