title: Successful treatment of resistant alopecia areata with a phototoxic dose of ultraviolet A after topical 8-methoxypsoralen application.
abstract: BACKGROUND
  The efficacy of a phototoxic dose of ultraviolet A (UVA) after topical application of 8-methoxypsoralen (8-MOP) in the treatment of alopecia areata (AA) was evaluated previously in only one study. However, the possibility of spontaneous regrowth of hair cannot be excluded as sessions were carried out every 3 months.
  
  
  OBJECTIVE
  To determine the efficacy of a phototoxic dose of UVA after topical application of 8-MOP in the treatment of AA resistant to other lines of treatment.
  
  
  METHODS
  Thirty-five patients with AA were treated by topical 8-MOP application to the lesions followed by UVA irradiation using a phototoxic dose every 3 months for a maximum of four sessions. Severity grading of AA was carried out using the Severity of Alopecia Tool (SALT) score before and after treatment.
  
  
  RESULTS
  Fifty-seven percent of patients showed a positive treatment response (40% showed complete and 17% showed partial response) with significant improvement of SALT score. The mean cumulative UVA dose was 22±8.3 J/cm(2). Mild reversible side effects were observed in 63% of patients after the first session.
  
  
  CONCLUSIONS
  Phototoxic psoralen and ultraviolet A therapy after topical application of 0.1% 8-MOP is an effective treatment option for resistant AA, with low total cumulative UVA dose, few treatment sessions, and minimal reversible side effects.
authors.affiliation: Department of Dermatology and Venereology, Ain Shams University, Cairo, Egypt.
authors.forename: Mostafa Mokhtar
authors.initials: MM
authors.lastname: Kamel
authors.forename: Samar Abdallah Mohamed
authors.initials: SA
authors.lastname: Salem
authors.forename: Hanan Hamdy M
authors.initials: HH
authors.lastname: Attia
mesh_terms: D000293:Adolescent; D000328:Adult; D000506:Alopecia Areata / Q000188:drug therapy*; D005260:Female; D006197:Hair / Q000254:growth & development; D006801:Humans; D008297:Male; D008730:Methoxsalen / Q000627:therapeutic use*; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014467:Ultraviolet Therapy; D055815:Young Adult
chemical_list: D017319:Photosensitizing Agents; D008730:Methoxsalen