title: Liquid Nitrogen Cryotherapy in Recalcitrant Alopecia Areata: A Study of 11 Patients.
abstract: BACKGROUND
  Recalcitrant alopecia areata (AA) is not uncommon in clinical practice. In certain patients, treatment failures are known with almost every conventional therapy either singly or in combination.
  
  
  OBJECTIVE
  To study the efficacy of liquid nitrogen (LN) cryotherapy in patients with recalcitrant AA.
  
  
  METHODS
  We present series of eleven patients of recalcitrant AA, who consulted us after getting no response to various modalities of treatment for 6 months. We treated them with LN cryotherapy every 2 weeks till significant hair regrowth or maximum five sittings (at 0, 2, 4, 6, and 8 weeks) whichever was earlier. Inclusion and exclusion criteria were applied. Each patient was counseled and a written consent was taken. Every session consisted of dual freeze and thaw cycles of 15 s each with a cryo unit spray. Two months of follow-up after last treatment was done to observe sustained re-growth of hair.
  
  
  METHODS
  The clinical response was evaluated by using regrowth scale at 4(th), 8(th), and 16(th) week.
  
  
  RESULTS
  11 patients were recruited, one patient dropped due to inability to attend follow-ups. Remaining ten patients completed the treatment and follow-up. Out of 10 patients, five patients (50%) showed an excellent response, three (30%) had a satisfactory response, one (10%) had a fair response, and one patient (10%) had a poor response. No serious adverse effects were seen. Sustained hair regrowth was seen in 80% of patients at the 16(th) week.
  
  
  CONCLUSIONS
  LN cryotherapy may be worth trying treatment in the management of recalcitrant AA.
authors.affiliation: Department of Dermatology, Skin Diseases Centre, Nashik, Maharashtra, India.
authors.forename: Vijay P
authors.initials: VP
authors.lastname: Zawar
authors.affiliation: Department of Dermatology, Skin Diseases Centre, Nashik, Maharashtra, India.
authors.forename: Gayatri Mukund
authors.initials: GM
authors.lastname: Karad
keywords: Alopecia areata; cryotherapy liquid nitrogen; recalcitrant