The role of fractional laser‐assisted drug delivery in enhancing the efficacy of topical bimatoprost solution in the treatment of alopecia areata: An intra‐patient comparative randomized clinical trial

Abstract Background Transepidermal drug delivery is a novel therapeutic technique to boost efficacy of topical drugs. Aim In this clinical trial we evaluate the efficacy of the combination of fractional carbon dioxide (FCO 2 ) laser and bimatoprost solution compared to bimatoprost alone in the treatment of alopecia areata. Methods This is a prospective intra‐patient comparative randomized clinical trial on 20 patients with alopecia areata. In each participant two patches were chosen to randomly receive either topical 0.03% bimatoprost solution (twice a day for 12 weeks) alone or in combination with FCO 2 laser (every 2 weeks for 12 weeks). Then response to treatment was evaluated by the measurement of the severity of alopecia tool score system (SALT) score, percentage of hair regrowth, physician assessment and patients' satisfaction. Results SALT score was reduced significantly during treatment sessions and after a 3‐month follow‐up in both treatment groups ( p = 0.000). The mean percentage of improvement in SALT score in the combination therapy and monotherapy groups were 46.43 ± 4.35% and 21.16 ± 4.06% at the end of the study and 46.42 ± 5.75% and16.11 ± 3.10% at the end of the follow‐up period, respectively ( p = 0.000). A general linear model of two‐way analysis demonstrated a significantly superior outcome in the combination therapy group compared to the monotherapy group during time (F 1.6, 13.2 = 43.8. p = 0.000). Conclusion Fractional ablative laser can be considered as an assistant method for enhancing of efficacy of topical drugs especially in refractory cases of patchy alopecia areata.