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  • The main limitation of this study is

    2018-11-15

    The main limitation of this study is that the Chinese version of the questionnaire adopted in this study has not been proved as a reliable and valid measure of glp-2 disease on the quality of life in Taiwanese/Chinese patients. Nonetheless, the interviewer who was a dermatologist proficient in Chinese and English did his best efforts to explain in detail the contents of the questionnaire during the interview process to assist the patients in understanding and filling out the questionnaires. Besides, the He et al study shows that the Skindex-16 questionnaire is suitable for measuring the quality of life in Chinese patients with skin diseases.
    Conclusion
    Acknowledgments
    Introduction Alopecia areata (AA) is a nonscarring hair loss disease that is generally regarded as an autoimmune disorder mediated by T lymphocytes. In patients with limited involvement, AA is expected to be self-limited and spontaneous recovery is possible. However, in patients with higher severity, the treatment of AA is usually frustrating for both the patients and doctors because of the lack of definite responsiveness and high recurrence rate. The use of corticosteroids through a topical, intralesional, or systemic route is currently the mainstay of treatment. However, long-term usage of corticosteroids is limited by several well-documented side effects. An excimer light of 308-nm wavelength was used to treat vitiligo and psoriasis due to its suppressive effects on T lymphocytes, and was reported to elicit rapid responses in fewer treatments than narrow-band UV-B light. The promising effect of the excimer light in treating AA had also been shown in a few case reports or small case-series. In this study, we retrospectively reviewed our cases and aimed to show the efficacy of excimer light therapy and to identify clinical predictive factors.
    Methods
    Results There were 17 patients recruited in this study, including six males (35.3%) and 11 females (64.7%) (Table 1). The mean age was 34.6 years (range 10–64 years). Eight (47.1%) patients had a history of AA for more than 1 year. The initial severity of AA in these patients was mild (<50% hair loss) in seven patients (41.2%) and severe (≥50%) in 10 patients (58.8%), with five patients (29.4%) having complete loss of scalp hair during initial stages. The patients received a median of 37 sessions (range 14–118 sessions) of excimer light treatment. The median of the accumulated dose in a patient was 8.05 J/cm2 (range 3.4–75.6 J/cm2) and the median of the maximal dose in a single session in a patient was 0.45 J/cm2 (range 0.15–0.8 J/cm2). To analyze the factors phenotype were associated with favorable outcomes of excimer light treatment, the patients were classified into subgroups and the response rates were compared (Table 1). There was no significant difference in the response rates in different age, sex, or severity groups. However, patients with shorter AA durations (1 year or shorter, n = 9) had a more favorable response to excimer light treatment than patients with longer AA durations (longer than 1 year, n = 8; response rate 75.0% vs. 11.1%, p < 0.05).
    Discussion The overall response rate of excimer lamp treatment in treating AA was 41.2% and a satisfactory response was achieved in 29.4% of the patients. The response rate was lower compared to previous studies, probably due to the selection of refractory cases in our study (Table 2). To date, our study included the highest number of cases among all the series. It is noteworthy that in patients with higher severity (>50% hair loss), the overall response rate was 50% and the satisfactory response rate was 30%, suggesting that the excimer lamp could be considered as an alternative treatment even in patients with higher severity of AA. In our department, we would recommend patients with AA to receive intralesional corticosteroid injection or topical potent corticosteroid as the first-line treatment. For patients with extensive (>50%) hair loss that lasted less than 2 years, we would also recommend corticosteroid pulse therapy. If these therapies failed to yield positive effects after 3 months, excimer light therapy would be offered as one of the treatment choices.