Escalating dosimetry of UVA-1 in the treatment of alopecia areata.

Background: Phototherapy can be an option in unresponsive alopecia areata (AA); however, variable results have been reported with its use. We could not find literature of treatment with UVA-1 in AA. A study was designed to evaluate progressive dosimetry to determine the initial dose and its increments.

Methods: Patients with unresponsive AA were recruited. Twenty-five sessions of 30 J/cm were administered. If hair regrowth was <75%, the dose was escalated to 60 J/cm . If hair improvement remained <75%, an additional 25 sessions at 120 J/cm were indicated. If total hair regrowth occurred before 75 sessions, a final visit was performed for biopsies and severity of alopecia tool (SALT) evaluation. Clinical and histopathological assessments were performed blindly. Adverse effects were recorded.

Results: Nine men and 13 women were included; 16 were initially S , one S , and five S . Median age was 32 years and median evolution 10 months. Nine patients achieved an S , eight S , and five S (P = 0.005). The most notable improvement was with 60 J/cm (P = 0.02). Biopsies exhibited an absence of inflammation in five patients and mild persistence in 17. An increase of 43.75% in anagen hairs (P ≤ 0.001) was achieved, telogen hairs decreased 16.3% (P = 0.06), and catagen hairs were reduced 22.7% (P = 0.005). Pearson's correlation was -0.82 and P ≤ 0.001, when correlating anagen hairs with final SALT. Improvement has continued for 6 months post treatment. Mild xerosis was observed in all patients, and six (28.6%) developed transient mild hyperpigmentation.

Conclusions: This study provides a basis for UVA-1 dosimetry evaluating its therapeutic value in AA.