title: Escalating dosimetry of UVA-1 in the treatment of alopecia areata.
abstract: 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/cm2were administered. If hair regrowth was <75%, the dose was escalated to 60 J/cm2. If hair improvement remained <75%, an additional 25 sessions at 120 J/cm2were 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 S1, one S3, and five S4. Median age was 32 years and median evolution 10 months. Nine patients achieved an S0, eight S1, and five S4(P = 0.005). The most notable improvement was with 60 J/cm2(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.
authors.affiliation: Dermatology Department, Universidad Autonoma de Nuevo Leon, Facultad de Medicina, University Hospital, Monterrey, Mexico.
authors.forename: Maira E
authors.initials: ME
authors.lastname: Herz-Ruelas
authors.affiliation: Dermatology Department, Universidad Autonoma de Nuevo Leon, Facultad de Medicina, University Hospital, Monterrey, Mexico.
authors.forename: Minerva
authors.initials: M
authors.lastname: Gomez-Flores
authors.affiliation: Pathology Department, Universidad Autonoma de Nuevo Leon, Facultad de Medicina, University Hospital, Monterrey, Mexico.
authors.forename: Ivett
authors.initials: I
authors.lastname: Miranda-Maldonado
authors.affiliation: Dermatology Department, Universidad Autonoma de Nuevo Leon, Facultad de Medicina, University Hospital, Monterrey, Mexico.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Welsh
authors.affiliation: Dermatology Department, Universidad Autonoma de Nuevo Leon, Facultad de Medicina, University Hospital, Monterrey, Mexico.
authors.forename: Jorge
authors.initials: J
authors.lastname: Ocampo-Candiani
authors.affiliation: Dermatology Department, Universidad Autonoma de Nuevo Leon, Facultad de Medicina, University Hospital, Monterrey, Mexico.
authors.forename: Oliverio
authors.initials: O
authors.lastname: Welsh
mesh_terms: D000328:Adult; D000506:Alopecia Areata / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006197:Hair / Q000254:growth & development; D018859:Hair Follicle / Q000473:pathology* / Q000528:radiation effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D019233:Retreatment; D012535:Scalp / Q000473:pathology; D012720:Severity of Illness Index; D014467:Ultraviolet Therapy / Q000009:adverse effects / Q000379:methods*