Fractional Carbon Dioxide Laser in Combination with Topical Corticosteroid Application in Resistant Alopecia Areata: A Case Series

INTRODUCTION: Intradermal steroid injections are used as treatment option in resistant alopecia areata. However, it is difficult and quite painful to treat large areas of alopecia with this modality. OBJECTIVE: To assess the efficacy and safety profile of a combination of fractional carbon dioxide (CO(2)) treatment followed by topical corticosteroid application in resistant alopecia areata. MATERIALS AND METHODS: Ten cases of resistant alopecia areata who had not responded to multiple treatment modalities were treated with fractional CO(2) laser followed by topical application of triamcinolone spray (10mg/mL) on the resistant lesions. Patients received 4–8 sessions that were repeated at an interval of 3–4 weeks. Response to treatment was assessed on a quartile physician assessment scale and labeled as excellent (>75% regrowth), good (50%–75% regrowth), fair (26%–50% response), and poor (<25% regrowth). RESULTS: Eight of these ten cases completed the treatment process. Seven of these eight patients had complete recovery of the area treated. One patient however did not show good response even after four sessions. No significant adverse effects were noted in any of the patients. CONCLUSION: Fractional CO(2) laser in combination with topical triamcinolone can prove to be an effective treatment option in resistant alopecia areata.