الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Alopecia areata (AA) is a common non-scarring dermatological condition involving the scalp and/or body, characterized by hair loss without any clinical inflammatory signs. The onset may be at any age and there is no known race or sex preponderance. AA can present with different clinical manifestations varying from reversible patchy hair loss to complete baldness or complete body hair loss. The affected skin appears normal with no epidermal alteration grossly visible such as scaling or follicular abnormalities.
The clinical phenotype and disease course is variable, but the etiology for AA remains an enigma. About 28% of people with alopecia areata have a family history of the disease, indicating a genetic predisposition. Associations have been reported with a variety of genes, including major histocompatibility complex, cytokine and immunoglobulin genes, suggesting that the genetic predisposition is multifactorial in nature. The hair follicle lesion is probably mediated by T lymphocytes. The association between alopecia areata and other autoimmune diseases suggests that alopecia areata is itself an autoimmune disease.
The course of AA is unpredictable. Up to 50% of patients will recover within 1 year even without treatment. However, most patients will have more than one episode of hair loss. Although diagnosing alopecia areata is usually easy, treating it is not.
Diagnosis and therapy of hair and scalp diseases were supjected to significant progress in the last years. One of the major developments was employing imaging techniques, including hair and scalp folliscope. Although folliscope is one of the non-invasive imaging techniques, it allows the visualization of hair at high magnification and the measurement of relevant trichologic structures.
The treatment of AA depends on the severity and extent of the disease. The medications include corticosteroids, minoxidil, anthralin, topical immunotherapy, phototherapy, prostaglandin analogues, mesotherapy, platelet rich plasma (PRP) and fractional CO2 laser.
Fractional photothermolysis is a newly introduced laser technique. Its action depends on the production of a unique thermal damage pattern called ‘microthermal treatment zones (MTZ)’ and characteristically spares the tissue surrounding each MTZ. It keeps the stratum corneum intact and creates ‘fractional’ microscopic thermal columns in the dermis. Re-epithelialization occurrs during the first 24 hours via migration of keratinocytes from the surrounding normal tissue of the microthermal zones, with persistent dermal collagen remodeling response lasting at least 3 months after fractional laser treatment
Recently Fractional CO2 laser can be applied in treatment of AA, the mechanism of action of Fractional CO2 laser in treatment of AA is thought to be induction of T cell apoptosis, arresting the hair follicles in telogen stage and promoting the anagen stage and denovo neogenesis of the hair follicles from non-hair follicle stem cell.
The aim of this study was to provide a comparative evaluation of the effect of fractional CO2 laser versus intralesional steroids in treatment of Alopecia Areata.
Our study included 20 patients with at least 2 patches of AA. The 1st patch was treated with FCO2 laser, while the second patch with ILCs. All patients were photo documented before and after treatment.
Each patient was subjected to a detailed history taking, general, dermatological and folliscopic examination. The obtained data were tabulated and subjected to statistical analysis using different tests of significance.
The study showed superiority of FCO2 laser over ILCs in treatment of AA according to MISP, patient satisfaction and folliscopic examination of hair density with statistically significant difference.
Side effects with FCO2 laser treatment included pain during the laser session, and transient post-treatment crusting, scaling, erythema, and edema occurred with all the 20 cases. On the other hand the common adverse effects noted during ILCs therapy was pain during injection.
Our present study could not show any correlations between therapeutic response and age of the patients, duration of the disease, family history and past history of previous attack, except +ve correlation was found between sex of patient and MISP with ILCs being higher among males more than females.
Furthermore, no significant relapse was noticed among patients after 3 months of treatment with FCO2 laser or ILCs.
In conclusion, our study showed that treatment with FCO2 laser has a higher efficacy in treatment of AA in comparison to the traditional ILCs injection