Clinical and trichoscopic evaluation of trichloroacetic acid 35% vs phenol 88% peels in treatment of alopecia areata.
alopecia areata
chemical peel
phenol
trichloroacetic acid
trichoscopy
Journal
Journal of cosmetic dermatology
ISSN: 1473-2165
Titre abrégé: J Cosmet Dermatol
Pays: England
ID NLM: 101130964
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
08
02
2020
revised:
30
03
2020
accepted:
28
04
2020
pubmed:
22
5
2020
medline:
15
5
2021
entrez:
22
5
2020
Statut:
ppublish
Résumé
Among alopecia areata (AA) treatments, contact irritants (anthralin) and topical immunotherapies (diphenylcyclopropenone) have been successfully used. Chemoexfoliation can potentially be utilized, acting as irritants and consecutively immunomodulators. Peels via therapeutic wounding provoke growth factors and cytokines that may induce hair regrowth. To evaluate and compare trichloroacetic acid (TCA) 35% and phenol 88% peels effectiveness and tolerability in patchy AA. This comparative, randomized, double-blind study included 20 patients with multifocal patchy AA. In each patient, 2 patches were selected and randomized into group I (20 patches: TCA 35%) and group II (20 patches: phenol 88%). A session was performed every 3 weeks for 9 weeks. Response was assessed by two blinded observers as regards percentage of clinical improvement, severity of alopecia tool (SALT), and trichoscopic scaled scores for dystrophic and terminal hairs, respectively. Patients were scheduled for follow-up visits over 6 months past treatment cessation. A total of 19 patients completed the study and showed significant reduction in SALT score. TCA- and phenol-treated patches demonstrated significant improvement in the percentage of clinical improvement, trichoscopic scale of dystrophic and terminal hairs. However, TCA was superior to phenol as it showed significant more reduction in trichoscopic score of dystrophic hairs and significant higher increase in terminal hairs. Phenol yielded significant higher discomfort than TCA. No relapse was detected. Trichloroacetic acid 35% and phenol 88% peels can be considered effective therapeutic modalities for patchy AA. TCA 35% represents a treatment of choice in terms of the efficacy and tolerability.
Sections du résumé
BACKGROUND
BACKGROUND
Among alopecia areata (AA) treatments, contact irritants (anthralin) and topical immunotherapies (diphenylcyclopropenone) have been successfully used. Chemoexfoliation can potentially be utilized, acting as irritants and consecutively immunomodulators. Peels via therapeutic wounding provoke growth factors and cytokines that may induce hair regrowth.
AIM
OBJECTIVE
To evaluate and compare trichloroacetic acid (TCA) 35% and phenol 88% peels effectiveness and tolerability in patchy AA.
PATIENTS/METHODS
METHODS
This comparative, randomized, double-blind study included 20 patients with multifocal patchy AA. In each patient, 2 patches were selected and randomized into group I (20 patches: TCA 35%) and group II (20 patches: phenol 88%). A session was performed every 3 weeks for 9 weeks. Response was assessed by two blinded observers as regards percentage of clinical improvement, severity of alopecia tool (SALT), and trichoscopic scaled scores for dystrophic and terminal hairs, respectively. Patients were scheduled for follow-up visits over 6 months past treatment cessation.
RESULTS
RESULTS
A total of 19 patients completed the study and showed significant reduction in SALT score. TCA- and phenol-treated patches demonstrated significant improvement in the percentage of clinical improvement, trichoscopic scale of dystrophic and terminal hairs. However, TCA was superior to phenol as it showed significant more reduction in trichoscopic score of dystrophic hairs and significant higher increase in terminal hairs. Phenol yielded significant higher discomfort than TCA. No relapse was detected.
CONCLUSIONS
CONCLUSIONS
Trichloroacetic acid 35% and phenol 88% peels can be considered effective therapeutic modalities for patchy AA. TCA 35% represents a treatment of choice in terms of the efficacy and tolerability.
Substances chimiques
Phenols
0
Phenol
339NCG44TV
Trichloroacetic Acid
5V2JDO056X
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
143-149Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Thompson JM, Mirza MA, Park MK, Qureshi AA, Cho E. The role of micronutrients in alopecia areata: a review. Am J Clin Dermatol. 2017;18:663-679
Sinclair RD. Alopecia areata and suicide of children. Med J Aust. 2014;200:145
Ganjoo S, Thappa DM. Dermoscopic evaluation of therapeutic response to an intralesional corticosteroid in the treatment of alopecia areata. Indian J Dermatol Venereol Leprol. 2013;79:408-417
Hordinsky M, Donati A. Alopecia areata: an evidence-based treatment update. Am J Clin Dermatol. 2014;15:231-246
Xing L, Dai Z, Jabbari A, et al. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Nat Med. 2014;20:1043-1049
Jabbari A, Sansaricq F, Cerise J, et al. An open-label pilot study to evaluate the efficacy of tofacitinib in moderate to severe patch-type alopecia areata, totalis, and universalis. J Invest Dermatol. 2018;138(7):1539-1545
Olamiju B, Friedmann A, King B. Treatment of severe alopecia areata with baricitinib. JAAD Case Rep. 2019;5(10):892-894
Kar S, SinghN. Alopecia areata treated with phenolisation and intravenous dexamethasone pulses. Int J Trichology. 2013;5:47-49
Chikhalkar S, Jerajani H, Madke B. Evaluation of utility of phenol in alopecia areata. Int J Trichology. 2013;5:179-184
Singh G, Lavanya M. Topical immunotherapy in alopecia areata. Int J Trichology. 2010;2:36-39
Khunger N. Step by step chemical peels (2nd edn). New Delhi, India: Jaypee Brothers Medical Publisher (P) Ltd; 2014:81.
Wambier CG, Wambier SPF, Pilatti LEP, Grabicoski JA, Wambier LF, Schmidt A. Prolongation of rate-corrected QT interval during phenol-croton oil peels. J Am Acad Dermatol. 2018;78(4):810-812
Lee JB, Chung WG, Kwahck H, Lee KH. Focal treatment of acne scars with trichloroacetic acid: Chemical reconstruction of skin scars method. Dermatol Surg. 2002;28:1017-1021
Yonei N, Kanazawa N, Ohtani T, Furukawa F, Yamamoto Y. Induction of PDGF-B in TCA-treated epidermal keratinocytes. Arch Dermatol Res. 2007;299:433-440
Bechet PE. Extensive alopecia areata and result of treatment. Dermatologica. 1937;37:1073-1074
Saini R, Shishak M. Cost-effective therapeutic modalities in alopecia areata. EMJ Dermatol. 2017;5:61-62
Olsen EA, Hordinsky VH, Price VH, et al. Alopecia areata investigational assessment guideline- part II. J Am Acad Dermatol. 2004;51:440-447
Savant SS, Shenoy S. Chemical peeling with phenol: For the treatment of stable vitiligo and alopecia areata. Indian J Dermatol Venereol Leprol. 1999;65:93-98
O'Connor AA, Lowe PM, Shumack S, Lim AC. Chemical peels: a review of current practice. Australas J Dermatol. 2018;59:171-181
Beeson WH. Facial rejuvenation: Phenol-based chemoexfoliation. In: Coleman WP, Lawrences N, eds. Skin Resurfacing. Baltimore, MD: Williams and Wilkins; 1998:71-86
Puri N, Puri A. a comparative study on 100% TCA versus 88% phenol for the treatment of vitiligo. Our Dermatol Online. 2012;3(3):184-186
Wambier C, King B. Rethinking the classification of alopecia areata. J Am Acady Dermatol. 2018;80(2):e45
Dalpizzol M, Weber MB, Mattiazzi AP, Manzoni AP. Comparative study of the use of trichloroacetic acid and phenolic acid in the treatment of atrophic-type acne scars. Dermatol Surg. 2016;42(3):377-383
El-Mofty M, Mostafa WZ, Esmat S, et al. Site-oriented depigmentation in vitiligo patients using Q-switched Nd:YAG laser (1,064/532 nm), cryotherapy and chemical peels: a comparative study. Dermatol Ther. 2019;32(5):e13052