Photodynamic Therapy with Methyl 5-Aminolevulinate Acid Might Be Ineffective in Recalcitrant Alopecia Totalis Regardless of Using a Microneedle Roller to Increase Skin Penetration

Abstract

BACKGROUND Photodynamic therapy (PDT) with aminolevulinic acid or methyl 5-aminolevulinic acid (MAL) has been tried for the treatment of alopecia areata (AA). Unfortunately, the efficacy of PDT in treating AA is still being debated, and most clinical trials have produced disappointing results, which may have been because of the lack of treatment rationale or because of drug penetration. In several clinical trials of PDT in AA, the dermatologists suspected that skin preparations, including mechanical or chemical peeling, might be incomplete for drug penetration. OBJECTIVE In this pilot study, the efficacy of PDT in treating AA was investigated, and the treatment effect of the use of a microneedle roller for the enhancement of the transepidermal drug delivery system was evaluated. MATERIALS AND METHODS Eight Korean patients with alopecia totalis were enrolled in this study. Before the PDT, the right sides of the patients' scalps were prepared using 70% alcohol dressing and microneedle rolling, and the left sides (the control sides, without microneedle rolling) were only cleansed with 70% alcohol dressing. Immediately after the microneedle roller preparation, MAL was applied on the right scalp area under occlusion for 3 hours. Both sides were then illuminated with a red light (average wavelength, 630 nm; light dose, 37 J/cm2) for 7.5 minutes. Each patient received three treatments at 4-week intervals. A photograph of each patient was taken before and after the treatment. Biopsy was performed on the samples that were taken from both sides of the alopecia totalis lesions after 16 weeks (4 weeks after the final treatment). RESULTS After the three treatments, none of the patients achieved hair growth in the microneedle-rolled lesion or in the unrolled lesion. Furthermore, there was no increment in the density of the anagen hair follicles and no difference in the histologic findings of the groups. CONCLUSION PDT with MAL may not be effective for the treatment of alopecia totalis, regardless of the use of a microneedle roller to increase skin penetration. The authors have indicated no significant interest with commercial supporters.