Superficial cryotherapy versus topical psoralen and ultraviolet A in the treatment of alopecia areata: a randomized, controlled trial

Abstract

Background Alopecia areata (AA) is a prevalent autoimmune skin disease with no definitive cure or standard therapeutic options. Topical psoralen and ultraviolet A (PUVA) proved to be effective in the treatment of AA, while superficial cryotherapy has been described in the literature as one of the emerging unconventional therapies for AA with varying degrees of success. Objective To clarify and compare the therapeutic efficacy and safety of superficial cryospray versus topical PUVA in the treatment of mild-to-moderate AA. Patients and methods Fifty-two patients with mild-to-moderate AA were recruited and assigned into two groups. Group 1 included 27 patients who were treated with superficial liquid nitrogen cryospray every 2 weeks for 12 weeks and group 2 included 25 patients treated with topical PUVA twice weekly for 6 weeks. Patients showing more than 25% terminal hair regrowth are considered responders. Results An excellent response was obtained in 33% (9/27) of the patients in group 1 treated with cryospray compared with 28% (7/25) in group 2 treated with topical PUVA. However, a satisfactory response was achieved in 29.6% (8/27) of the patients in group 1 compared with 52% (13/25) in group 2 with statistically insignificant difference. Both therapeutic modalities were well tolerated with minimal side effects. Conclusion Superficial liquid nitrogen cryospray is a comparable therapeutic option to topical PUVA in mild-to-moderate AA. Moreover, it has the advantage of being a simple, convenient, short-term, and office-based technique.