308-nm excimer laser therapy in alopeciaareata
To the Editor: Alopecia areata (AA) is believed to bea T-cell autoimmune disorder, and 308-nm excimerlaser is able to induce T-cell apoptosis in vitro,suggesting that this laser might be effective intreating this disease. We have performed a compar-ative prospective intraindividual study to access theeffectiveness of the 308-nm excimer laser in thetreatment of AA.
Nine patients were included in the study. The
laser used was a 308-nm excimer laser (Talos,Wavelight
Germany). Each lesion was treated twice a weekfor a maximum of 24 sessions. Initial fluencies were
Fig 1. A, Alopecia areata patches before treatment. B,
50 mJ/cm2 less than minimal erythema dose. Then
fluencies were increased from 50 mJ/cm2 every twosessions. Each treated lesion had an opposite side
comparisons between the results obtained from these
untreated target lesion serving as a control.
various treatments are difficult because of the hetero-
Tolerance was evaluated with a visual analogue
geneity of AA in its presentation and its responses to
scale (0 = poor, 10 = excellent). Efficacy was blindly
treatments. Thanks to its good tolerance, pho-
evaluated by two independent physicians on direct-
totherapy is an attractive treatment. Several studies
light photos (Fujifilm Finepix S1 Pro; Fujifilm Ltd,
have been reported concerning the efficacy of sys-
Tokyo, Japan) taken before sessions, at the end of
temicand topical psoralen-UVA therapin the
the sessions, and 3 months after sessions. Regrowth
treatment of AA. Paradoxical response rates were
was graded on a 6-point scale (0 = no hair regrowth,
reported in the literature. Interestingly, preliminary
1 = hair regrowth 1%-24%, 2 = hair regrowth 25%-
efficacy of narrowband UVB phototherapy for AA was
49%, 3 = hair regrowth 50%-74%, 4 = hair regrowth
reported recently in a left-right monitored pilot stud
75%-99%, and 5 = complete hair regrowth). At the
This report underscores the potential efficiency of
final visit, the patients’ opinions about treatment
effectiveness and the degree of satisfaction were
In conclusion, the 308-nm excimer laser appears
recorded (excellent, good, moderate, poor).
to be a good therapeutic alternative for AAP.
The results are summarized in . Our study
Nevertheless, additional monitored studies on
shows that 308-nm excimer laser induces effective
a larger population are necessary to validate our
hair regrowth in all patients with alopecia areata
partialis (AAP) ). The occurrence of hair re-
growth only on the treated patches proves the
efficiency of this therapy and excludes the possibility
of spontaneous hair regrowth that should be always
considered when evaluating AA treatments. None of
these patients lost their hair over a follow-up period of
Department of Dermatology, Hoˆpital de l’Archet
3 months. On the other hand, no hair regrowth was
observed in patients with either alopecia areatauniversalis (AAU) or alopecia areata totalis (AAT).
Moreover, the small size of the hand piece (maximum
Department of Dermatology, Archet-2 hospital
25-mm diameter) makes the treatment of the entire
scalp long and tiresome. These results are in agree-
ment with the prognosis factors usually observed inAA. Interestingly, only a few sessions were necessaryto obtain aesthetically correct results in AAP. Theseresults were obtained from moderate accumulated
REFERENCES1. Novak Z, Bonis B, Baltas E, Ocsovszki I, Ignacz F, Dobozy A, et al.
doses. The side effects were limited to mild erythema
Xenon chloride ultraviolet B laser is more effective in treating
and hyperpigmentation, and the tolerance was excel-
psoriasis and in inducing T cell apoptosis than narrow-band
lent. Many therapies have been tried for AA, but
ultraviolet B. J Photochem Photobiol B 2002;67:32-8.
(0%); minoxidil5% (0%); systemicsteroid (0%)
AA, Alopecia areata; F, female; M, male; MED, minimal erythema dose. Hair regrowth: 0 = no hair regrowth, 1 = hair regrowth 1% to 24%, 2 = hair regrowth 25% to 49%, 3 = hair regrowth 50% to 74%, 4 = hairregrowth 75% to 99%, and 5 = complete hair regrowth.
2. Claudy AL, Gagnaire D. PUVA treatment of alopecia areata. Arch
A 34-year-old woman in the third month of
pregnancy presented with facial erythema and pru-
3. Taylor CR, Hawk JL. PUVA treatment of alopecia areata partialis,
ritic papules on the dorsal hands, elbows, and knees.
totalis and universalis: audit of 10 years’ experience at St John’sInstitute of Dermatology. Br J Dermatol 1995;133:914-8.
The rash had appeared at 4 weeks’ gestation. She had
4. Behrens-Williams SC, Leiter U, Schiener R, Weidmann M, Peter
not taken any medicine before the rash appeared.
RU, Kerscher M. The PUVA-turban as a new option of applying
She did not complain of muscle pain or weakness. In
a dilute psoralen solution selectively to the scalp of patients
her first pregnancy, she delivered a healthy baby and
with alopecia areata. J Am Acad Dermatol 2001;44:248-52.
had had no cutaneous complications. There was no
5. Bolduc C, Hobbs L, Shapiro J, McLean D, Lui H. Efficacy of
narrow-band UVB in the treatment of alopecia areata. Poster
personal or family history of connective tissue
presented at: Third Intercontinental Meeting of Hair Research
Examination revealed discrete pruritic red-purple
papules over the bony prominences. Periungual
telangiectasia was also observed. She had exudativeerythema bridging the nose (Fig 1). A skin biopsyspecimen from her elbow was compatible with DM(Fig 2). Results of complete blood counts, blood
biochemistry analysis, and urinalysis were within
normal limits. Although antinuclear antibody titer
To the Editor: Amyopathic dermatomyositis (ADM)
(1:40) was positive in a nucleolar pattern, other
presents with pathognomonic cutaneous manifesta-
autoantibodies were negative. Based on these
tion of dermatomyositis (DM) but without associated
findings, this patient was diagnosed with ADM.
skeletal muscle involvement. ADM associated with
Potent topical steroids were prescribed but the
eruption did not improve. She delivered a healthy
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