Med Laser  
Fractional Laser and Low-level Light Combination Therapy in Patients with Recalcitrant Alopecia Areata
Kwang Ho Yoo1, Joon Seok2, Sun Young Choi2, Beom Joon Kim2
1Department of Dermatology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
2Department of Dermatology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
Correspondence to: Beom Joon Kim
E-mail: beomjoon74@gmail.com
ORCID: https://orcid.org/0000-0003-2320-7621
Received: March 8, 2022; Accepted: March 27, 2022; Published online: April 12, 2022.
© Korean Society for Laser Medicine and Surgery. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background and Objectives
The current treatment options for alopecia areata (AA) typically aim to suppress inflammatory T-cell responses. Patients vary in their response to these treatments, and some do not respond to one or more types of therapy. Herein, we report the outcomes of combination therapy, employing fractional laser treatment and low-level light therapy (LLLT), with a focus on patients with recalcitrant AA.
Materials and Methods
LLLT (HEALITE II®; Lutronic, Goyang, Korea) and fractional laser treatment (StarluxTM 1540; Palomar Medical Technologies Inc., Burlington, MA, USA) were administered to the subjects every two weeks. Two dermatologists independently compared photographs taken at baseline and final follow-up visits and assessed the level of hair regrowth using a 5-point scale. The scale levels and their description are as follows: 0, no improvement; 1, < 25% (slight improvement); 2, 25-50% (moderate improvement); 3, 50-75% (marked improvement); and 4, 75-100% (most improvement).
Results
Twenty patients (13 men and 7 women) were evaluated in this study. The mean improvement level was 2.55 points with 55% (n = 11) of patients showing > 50% improvement. No serious adverse events occurred, and treatment cessation was never deemed necessary.
Conclusion
Based on the results of this study, we propose that combination therapy may represent a viable new approach for the treatment of recalcitrant AA.
Keywords: Combination therapy; Fractional laser; Low level light therapy; Recalcitrant alopecia areata

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