Cryotherapy Versus Steroids In Alopecia Areata:Trichoscopic Evaluation

Learn more about:
Related Clinical Trial
A Study With Jaktinib Hydrochloride Cream Applied Topically to Subjects With Alopecia Areata Modified SALT Score for Alopecia Areata Safety and Efficacy of Bimatoprost Solution in Treating Eyelash Loss or Hypotrichosis in Children Comparative Study Examining the Effectiveness in Use of a DERMOJET and a Normal Syringe Treatment for Patients With Hair Loss – Alopecia Areata TREg Activation in the Treatment of the PELADE (Alopecia Areata) The Effectiveness of Mindfulness Based Cognitive Group Therapy for Social Anxiety Symptoms in People Living With Alopecia Areata Response of Topical Capsaicin in Alopecia Areata Efficacy of Twice Daily Application of LEO 124249 Ointment 30 mg/g for 12 Weeks on Eyebrow Alopecia Areata. Jaktinib Dihydrochloride Monohydrate in Severe Alopecia Areata Study to Evaluate the Safety and Efficacy of CTP-543 in Adult Patients With Moderate to Severe Alopecia Areata Extension Study to Evaluate Safety and Efficacy of CTP-543 in Adults With Alopecia Areata A Study of ATI-50002 Topical Solution for the Treatment of Alopecia Areata Follicular Revival in Treatment-resistant Alopecia Areata: Evaluating Use of Micro-needling Cryotherapy Versus Steroids In Alopecia Areata:Trichoscopic Evaluation Efficacy and Tolerability Study of Two Dose Regimens of CTP-543 in Adults With Alopecia Areata Efficacy and Tolerability Study of Two Dosing Regimens of CTP-543 in Adults With Alopecia Areata The Efficiency Of The Methotrexate At Patients Affected By Grave Pelade Stem Cell Educator Therapy in Alopecia Areata Comparative Study for Treatment of Alopecia Areata Using Carboxytherapy and Intralesional Steroids The Comparison Study of Intralesional Botulinum Toxin A and Corticosteroid Injection for Alopecia Areata Adrenal Function and Use of Intralesional Triamcinolone Acetonide 10 mg/mL (Kenalog-10) in Patients With Alopecia Areata Vytorin in the Treatment of Alopecia Areata Combined Restylane and Triamcinolone Acetonide Injections for the Treatment of Alopecia Areata The Efficacy and Safety of Different Concentrations of Localized Injections of Steroids in the Treatment of Alopecia Areata Transepidermal Delivery of Triamcinolone Acetonide or Platelet Rich Plasma Using Either Fractional Carbon Dioxide Laser or Microneedling in Treatment of Alopecia Areata A Trial of Clobetasol Propionate Versus Hydrocortisone in Children With Alopecia Areata Efficacy and Safety of LH-8 in Paediatric Alopecia Areata Comparison of Topical Latanoprost vs Topical Corticosteroid in Treatment of Localized Alopecia Areata Intralesional Steroids in the Treatment of Alopecia Areata A Phase II Study in Patients With Alopecia Areata Topical Crisaborole in Patients With Alopecia Areata Efficacy of Hair Transplantation Compared With Hypodermic Needle Irritation in Alopecia Areata A Study of Baricitinib (LY3009104) in Adults With Severe or Very Severe Alopecia Areata A Study of Baricitinib (LY3009104) in Participants With Severe or Very Severe Alopecia Areata Efficacy of Fractional CO2 Laser as a Mono- or Adjuvant Therapy for Alopecia Areata Characteristics of T Cells From Alopecia Areata Scalp Skin Before and After Treatment With Aldara 5% Efficacy Study of a Cosmetic Lotion in the Treatment of Alopecia Areata in Males and Females Excimer Light for Alopecia Areata Biocellular-Cellular Regenerative Treatment Scaring Alopecia and Alopecia Areata Safety and Efficacy Study of SHAPE Gel in Alopecia Areata Efficacy Study of Latanoprost and Bimatoprost Solutions in Promoting Eyelash Growth in Patients With Alopecia Areata Topical Garlic Concentrate for Alopecia Areata in Children Pilot Study to Evaluate the Efficacy of Ruxolitinib in Alopecia Areata Aldara for the Treatment of Extensive Alopecia Areata A Clinical Trial to Evaluate the Efficacy of Abatacept in Moderate to Severe Alopecia Areata Topical Calcipotriol Versus Narrowband Ultraviolet B in Treatment of Alopecia Areata LEO 124249 Ointment in the Treatment of Alopecia Areata Childhood Alopecia Areata Study Using the 308-nm Excimer Laser Alefacept in Patients With Severe Scalp Alopecia Areata Treatment of Alopecia Areata of the Scalp With Intradermal Injections of Botulinum Toxin Evaluation of the Efficacy and Tolerability of Treatment With Interleukin-2 in Severe and Resistant Alopecia Areata

Brief Title

Cryotherapy Versus Steroids In Alopecia Areata:Trichoscopic Evaluation

Official Title

Cryotherapy Versus Intralesional Corticosteroid Injection In Treatment Of Alopecia Areata: Trichoscopic Evaluation

Brief Summary

      Alopecia areata is the most frequent cause of inflammation-induced hair loss with prevalence
      from 0.1 to 0.2%. It has no age nor sex predilection .

      Clinically, alopecia areata presents as a well-circumscribed patch of sudden hair loss. It
      affects any hair bearing area. The most common affected site is the scalp. Based on site and
      extent, AA can be classified into; diffuse, multi-locularis, mono-locularis, totalis,
      universalis, and ophiasis.

Detailed Description

      Histologically, lesional biopsies of alopecia areata demonstrate a peri_follicullare and
      intra_folliculare mononuclear cell infiltrate around anagen phase hair follicles .The
      infiltrate consists mostly of activated lymphocytes in particular CD4 cells as well as
      dendritic cells and macrophages.

      Many theories were implicated in pathogenesis of alopecia areata such as; autoimmune
      lymphocytic attack of the hair, genetic basis and environmental factors. So the pathogenesis
      of alopecia areata remains to be determined. Currently a widely accepted theory is the
      autoimmune etiology. Specific T_cell lymphocytes, autoantibodies against anagen follicles,
      and various cytokines such as interferon-γ, interleukins, and tumor necrosis factor-α have
      been found to play a major role in alopecia areata. In addition, the immune privilege theory
      has been recently introduced and suggested to play a role in the pathogenesis.

      Many kinds of treatment modalities are present in localized alopecia areata. Injectable forms
      of corticosteroids are first line of alopecia areata therapy, and also topical use of
      steroids is widely used. Others are topical sensitization with anthrain, minoxidil and
      cryotherapy. In extention form of alopecia areata, systemic treatments like corticosteroids,
      cyclosporine and methotrexate can be used.

      Intralesional Corticosteroid injection:

      National Guidelines from British Association of Dermatologists, recommend intralesional
      corticosteroid therapy as the first line treatment for localized patchy alopecia areata, with
      approximate success rates of 60-75%. Their use was first described in 1958, with the use of

      Immunosuppression is the main mechanism of action. Corticosteroids suppress the
      T-cell-mediated immune attack on the hair follicle. Steroids with low solubility are
      preferred for their slow absorption from the injection site, promoting maximum local action
      with minimal systemic effect. The efficacy of intralesional corticosteroid injection is
      variable depending on the patient population treated.


      Cryotherapy may act through either singly or by a combination of the following mechanisms
      resulting in hair regrowth in alopecia areata. After initial vasoconstriction with
      cryotherapy, there is a significant local vasodilatation during the thaw period as the
      temperature reaches zero degree Celsius. Thus, cryotherapy is speculated to dilate the
      vessels around the affected hair follicles, with an increase in the blood flow leading to
      follicular hair regrowth. Moreover, local edema and inflammation occurring after cryotherapy
      may play a role in inducing vasodilation.

      Cryotherapy is also speculated to inflict partial damage to keratinocytes, especially the
      antigenic components of the hair follicle keratin16 and trichohyalin, which are targeted by
      antibodies and thus, further decrease in damaging perifollicular infiltrate.

      Cryotherapy may also alter tissue Langerhans cells, which in turn could alter the process of
      antigen presentation with further decrease in T cell infiltration. As it is known, the white
      hairs are spared in alopecia areata; it is hypothesized that melanocytes may have a role in
      the pathogenesis ofalopecia areata. Hence, cryotherapy may also act by destructing the
      melanocytes further preventing their role in the initiation of alopecia areata.


      Dermoscopy is now considered as a valuable tool in diagnosis of variable skin lesions. It is
      a non-invasive procedure which was initially used to assess pigmented lesions.

      Scalp dermoscopy (Trichoscopy) does not only facilitate diagnosis of hair disorders but also
      give clues about disease stage and progression. Trichoscopy allows the superimposition of the
      skin layers with the possibility to observe any surface or deep skin layers.

      The most common trichoscopic features of alopecia areata are yellow dots, micro-exclamation
      mark hairs, tapered hairs, black dots, broken hairs, and regrowing upright or regrowing
      coiled hairs. Black dots as remnants of exclamation mark hairs or broken hairs provide a
      sensitive marker for disease activity as well as severity of alopecia areata. Yellow dots,
      are considered to be the most sensitive dermoscopic feature of alopecia areata. Tapering hair
      is considered as a marker of disease activity and known to reflect exacerbation of disease.
      Trichoscopic characteristics have a clinical significance in alopecia areata for diagnosis
      and prognosis.

      Severity of alopecia tool Score:

      National Alopecia Areata Foundation working committee has devised "Severity of Alopecia Tool
      score. Severity of alopecia tool score is useful to find out the quantitative assessment of
      scalp hair loss.

Study Phase

Phase 4

Study Type


Primary Outcome

The incidence of patietns with hair regrowth


Alopecia Areata



Study Arms / Comparison Groups

 study group
Description:  •The first group (20 patients) will be treated with cryotherapy using liquid nitrogen spray, two cycles each one 3-5 seconds, one session every two weeks, for three months.


* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.

Recruitment Information

Recruitment Status


Estimated Enrollment


Start Date

November 2018

Completion Date

September 2019

Primary Completion Date

July 2019

Eligibility Criteria

        Inclusion Criteria:

          -  Age >12 years.

          -  Both sexes will be included.

          -  Newly diagnosed cases.

        Exclusion Criteria:

          -  Children < 12 years.

          -  Pregnancy and lactation.

          -  Patients with active scalp infection.

          -  Patients with cold sensitivity (regarding the first group).

          -  Any newly onset medical systemic illness.




12 Years - N/A

Accepts Healthy Volunteers



, 01064447881, [email protected]

Location Countries


Location Countries


Administrative Informations



Organization ID


Responsible Party

Principal Investigator

Study Sponsor

Assiut University

Study Sponsor

, , 

Verification Date

March 2018