Clinical Observation Of Fractional Carbon Dioxide Laser Therapy Alone Or Combined With Local Applications Of Glucocorticoid In The Treatment Of Alopecia Areata

Objective1.To investigate and analyze the demographic characteristics,clinical features,concomitant diseases,and quality of life of patients with alopecia areata;2.To evaluate the efficacy and safety of Fractional carbon dioxide laser therapy alone or combined with local applications of glucocorticoid in the treatment of alopecia areata,to lay a theoretical basis for its future improvement.MethodsThirty-two patients with alopecia areata who came to seek medical care in the First Affiliated Hospital of Dali University from January 2022 to September 2022,and met the inclusion criteria were selected.1.Analysis of the clinical features of the patients（1）The demographics,clinical data and Dermatology Life Quality Index（DLQI）were collected through questionnaires.（2）The data was recorded and a descriptive analysis was made towards it.2.Analysis of the clinical efficacy of Fractional carbon dioxide laser therapy alone or combined with local applications of glucocorticoid in the treatment of alopecia areata（1）The 32 patients were enrolled in a self-controlled case series study.One or more alopecia areas were selected according to the actual hair loss of each patient and were roughly divided into 4 groups.Control group with intralesional injections of Compound Betamethasone Injection alone;Treatment group 1 was treated with Fractional carbon dioxide laser（FRCO₂laser）alone;Treatment group 2 with FRCO₂laser combined with external applications of Compound Betamethasone Injection;and treatment group3 with FRCO₂laser combined with intralesional injections of Compound Betamethasone Injection.The treatment was given 3 times to the patients,with each interval lasting for 4 weeks in between.The consent for treatment was signed and relevant examinations were completed before the process,and photos were taken before and after each treatment.The Severity of Alopecia Tool（SALT）was used to evaluate the hair loss conditions.The clinical efficacy was assessed and adverse reactions were recorded 4 weeks after the last treatment.Then the patients were asked to comment on the efficacy and were followed up for 3 months for any recurrences of the disease.（2）At the end of the process,the collected data were classified and statistically analyzed to help come to conclusions.Results1.Clinical features of the patients（1）Demographics:the ratio of male to female was 1:1.13,with no significant gender difference.The oldest patient was 64 years old,and the youngest was 17.The average age was 34±10.66 years old,while most of them were between 20-39 years old.（2）The majority of the patients were with patchy alopecia areata（24,75.0%）;the longest and shortest durations were 11 years and 5 days,with an average length of4.86±2.52 months;the numbers of patients in the active,stable and recovery stages were12（37.5%）,13（40.6%）,and 7（21.8%）,respectively;15 cases were mild（46.8%）,14moderate（43.7%）,and 3 severe（9.4%）;12 patients had obvious triggering factors,including poor sleep in 8 cases（25.0%）,mental stress in 3 cases（9.4%）,and hair dye in1 case（3.1%）;only 4 patients（12.5%）had a family history of the disease.（3）In addition,9 patients（28.12%）were accompanied by other diseases,including5 with allergic diseases,3 with thyroid diseases,and 1 with diabetes.（4）The average DLQI was 7.03 and the impact on the quality of life was moderate,according to the questionnaire.2.Analysis of the clinical efficacy of FRCO₂laser therapy alone or combined with topical applications of Compound Betamethasone Injection in the treatment of alopecia areata（1）The average SALT scores of control group,treatment group 1,treatment group2 and treatment group 3 before treatment was 7.31±2.17,7.25±2.18,7.23±2.22 and7.17±2.18,respectively,with no statistical significance（P>0.05）.After the treatment,the numbers decreased to 2.93±1.52,3.86±1.56,3.03±1.65,and 2.04±1.48（P<0.05）.The SALT scores of the 4 groups were statistically different,with control group’s slightly lower than that of treatment group 2（P>0.05）,group treatment group 1’s higher than that of control group,treatment group 2,and treatment group 3（P<0.05）,and treatment group 3’s was lower than that of control group and treatment group 2（P<0.05）.（2）After the treatment,the effective rates of control group,treatment group 1,treatment group 2 and treatment group 3 were 50.00%,25.00%,53.13%,and 78.13%,respectively,with statistical significance（P<0.05）.Control group’s was slightly lower than that of treatment group 2（P>0.05）;treatment group 1’s rate was lower than that of control group,treatment group 2 and treatment group 3（P<0.05）;and control group3’s was higher than that of control group and treatment group 2（P<0.05）.（3）There was statistical significance in the efficacy in active and non-active patients（P>0.05）,but not in the efficacy of patients with mild and moderate conditions in each group.（4）No obvious systemic adverse reactions were found in each group,but there was one main local adverse reaction:atrophy.The rates of atrophy in control group,treatment group 1,treatment group 2 and treatment group 3 were 21.9%,0%,0%,and18.8%,respectively（P<0.05）.The rates of atrophy in control group and treatment group 2 was higher than that in treatment group 1,treatment group 2;respectively,and the difference was statistically significant（P<0.05）,The rates of atrophy in control group was not statistically significant compared with that in treatment group 3（P>0.05）.（5）The satisfaction rates of control group,treatment group 1,treatment group 2 and treatment group 3 were 56.3%,28.1%,87.5%,and 84.4%（P<0.05）.（6）In the 3-month follow-up,4 patients were found with recurrence,but not at the previously treated area.Conclusions1.The 32 patients with alopecia areata in this study shows the following characteristics:the disease is commonly seen in young and middle-aged people,with no significant gender difference;patchy alopecia areata is the most common classification;mild to moderate cases are mostly seen,while severe cases are less so;the effect of the disease on patients’quality of life is moderate.2.FRCO₂laser alone can lower the SALT score,but its clinical efficacy is average.So it should be combined with other treatments to improve the performance.FRCO₂laser combined with external applications of Compound Betamethasone Injection,as effective as intralesional injections of Compound Betamethasone Injection alone,and with no obvious adverse reactions,could be used as a safe and effective alternative.FRCO2 laser combined with intralesional injection of compound betamethasone injection can significantly reduce the SALT score of patients with alopecia areata,with better efficacy than the other 3 treatments.3.The stage of the disease,be it active or non-active,has no effect on the efficacy of the treatment methods.The effects of each treatment on mild or moderate cases are equal.